急性期人布鲁氏菌病血清学和PCR检测效能评价

于建梅; 张媛媛; 房明; 于晓琳; 李岩; 丁淑军; 冯开军; 马秀君; 寇增强; 邢薇佳

doi:10.11847/zgggws1140324

急性期人布鲁氏菌病血清学和PCR检测效能评价

Evaluation on efficacy of serological and PCR detection for diagnosis of acute human brucellosis

摘要

摘要:
目的评价血清学和巢氏PCR检测对急性期布鲁氏菌病的临床检测效能及应用价值。
方法采用酶联免疫吸附实验（ELISA）、试管凝集实验（SAT）、抗人免疫球蛋白实验（Coomb′s）等血清学及巢氏PCR检测方法（nested-PCR）对115例布鲁氏菌病确诊患者血清样本进行检测，计算每种方法的检测结果，并进行统计学分析。
结果 ELISA-IgA、ELISA-IgM、ELISA-IgG、巢氏PCR、SAT、Coomb′s的阳性检出率分别为94.78%（109/115）、54.78%（63/115）、87.83%（101/115）、8.70%（10/115）、73.91%（85/115）、98.26%（113/115）；发病到确诊时间 < 15、15～29、30～44、45～59、> 60 d组不同检测方法的检测结果差异有统计学意义（分别为χ² = 108.91、103.04、50.75、27.73、34.16，均P < 0.05）；各检测方法检出率差异有统计学意义（H = 109.63，P < 0.05）。SAT与Coomb′s的实验滴度差异有统计学意义（Z = − 9.08， P < 0.05）。
结论血清学的阳性检出率明显高于巢氏PCR，因此，血清学检测依然是诊断布鲁氏菌病的最有效方法；Coomb′s检测阳性率最高，可作为SAT检测的补充方法。

Abstract:
Objective To evaluate the efficacy of serological and nested PCR detection for diagnosis of acute human brucellosis.
Methods Serum samples of 115 confirmed brucellosis patients were collected for detection of brucella-specific immunoglobulin (Ig) with enzyme-linked immunosorbent assay (ELISA), tube agglutination test (SAT), anti-human Ig test (Coomb′s) and brucella DNA with nested PCR. The detection results of different methods were analyzed statistically.
Results The positive rate of brucella-specific Ig was 94.78% (109/115) for ELISA-IgA, 54.78% (63/115) for ELISA-IgM, 87.83% (101/115) for ELISA-IgG, 73.91% (85/115) for SAT, and 98.26% (113/115) for Coomb′s test; and the positive rate of brucella DNA was 8.70% (10/115) for PCR detection. There was a significant difference in the positive rate of the detections using various methods among all the patients (H = 109.63, P < 0.05) and the difference was also significant for the detections among subgroup patients with diverse intervals of < 15 days (χ² = 108.91), 15 − 29 (χ² = 103.04), 30 − 44 (χ² = 50.75), 45 − 59 (χ² = 27.73), and > 60 (χ² = 34.16) between the disease onset and being diagnosed definitely (P < 0.05). The experimental titer differed significantly between SAT and Coomb′s test (Z = − 9.08, P < 0.05).
Conclusion The positive detection rate of serological test is significantly higher than that of nested PCR. Therefore, serological detection is still the most effective method for the diagnosis of brucellosis. Coomb′s test could be used as a supplementary method for SAT test.

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