2017年云南省疟疾病例复核及实验室诊断质量分析
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摘要
目的分析云南省疟疾病例复核及实验室诊断质量情况,为指导消除疟疾工作提供参考。方法对2017年云南省网络直报疟疾病例血样及发热病人阴性血片进行复核,评价血片质量并分析比较省级与州(市)或县级疟疾实验室检测能力(定性、虫种符合情况)。结果 2017年全省网报疟疾病例复核覆盖13个州市,复核率98.25%(337/343),较2015年和2016年分别上升3.41%和2.55%。经省级实验室镜检复核血片336例,阳性符合率94.05%(316/336),较2016年(95.1%)降低1.1%,虫种符合率96.52%(305/316),较2016年(92.3%)上升4.57%;抽检阴性血片1 505例,完成计划数的100.33%(1 505/1 500),阴性符合率100%。省级检测滤纸血膜341例,与州市、县级检测符合率96.77%(330/341),虫种符合率96.01%(313/326),较2016年分别上升1.76%和5.16%,同时检测阳性血涂片和滤纸血膜326例,省级镜检与基因检测结果一致313例,两种方法一致率为96.01%,不一致的13例中有9例为混合感染误判为单一虫种感染及镜检阴性基因检测阳性,占69.23%。2017年共分析1 841张血片,其中网报血片总得分80.09,综合判定合格率59.82%(201/336),抽检阴性血片总得分80.45,血涂片的制作、染色、清洁度与2016年基本一致,网报血片和抽检阴性血片间无差异(P>0.05)。结论 2017年云南省疟疾诊断实验室检测水平及诊断质量较往年整体有所提高,但在消除疟疾关键阶段,建议各实验室联合多种方法并进行疟疾检测,继续加强对检测人员的技能培训和质量控制,提升各防控部门的疟疾诊断能力。
Objective To analyze the quality of review and laboratory diagnosis of malaria cases in Yunnan Province in order to provide a reference for malaria elimination. Methods Blood samples from patients with malaria reported to the provincial network and malaria-negative blood smears from patients with a fever were reviewed to evaluate the quality of blood smears.Laboratory detection of malaria at the provincial and prefectural(city)level was compared to that at the county level(qualitative detection,coincidence of insect species)in Yunnan Province in 2017. Results Cases of malaria that were reported in the province in 2017 came from 13 municipalities.Cases were reviewed at a rate of 98.25%(337/343),reflecting a 3.41%increase from 2015 and a 2.55%increase from 2016.Three hundred and thirty-six blood samples were microscopically examined in the laboratory at the provincial level.The positive concordance rate was 94.05%(316/336),which was 1.1%lower than the rate in 2016(95.1%).The coincidence of insect species was 96.52%(305/316),which was 4.57% higher than the coincidence in 2016(92.3%).Of the 1,505 patients from whom negative blood smears were obtained,100.33%(1,505/1,500)completed the planned treatment,and the negative concordance rate was100%.Three hundred and forty-one blood samples on filter paper were tested at the provincial level.The concordance of malaria detection at the county level was 96.77%(330/341),and the coincidence of insect species was 96.01%(313/326).The concordance increased 1.76%from 2016 and the coincidence of insect species increased 5.16%.At the sametime,326 positive blood smears and blood samples on filter paper were tested.Microscopic examination at the provincial level and testing for malaria genes agreed for 313 of those smears and samples.The concordance rate of the two methods was 96.01%.Nine(69.23%)of 13 smears and samples where microscopic examination and gene testing disagreed were misdiagnosed as a single infection.In those 9 smears and samples,malaria was not detected by microscopy but malaria genes were detected.A total of 1,841 blood smears was analyzed in 2017.The total score for blood smears leading to a report of malaria was 80.09,and the overall rate of successful identification was 59.82%(201/336).The total score for negative blood smears was 80.45.The preparation and staining of blood smears and the cleanliness of slides were basically the same as in 2016.There were no differences between blood smears leading to a report of malaria and negative blood smears(P>0.05). Conclusion In 2017,the level of detection and quality of laboratory diagnosis of malaria improved overall in Yunnan Province in comparison to previous years.In this critical stage of malaria elimination,however,laboratories should use a combination of methods to perform malaria testing,continue to enhance the proficiency training of technicians and control quality,and improve the ability of prevention and control organizations to diagnose malaria.
Objective To analyze the quality of review and laboratory diagnosis of malaria cases in Yunnan Province in order to provide a reference for malaria elimination. Methods Blood samples from patients with malaria reported to the provincial network and malaria-negative blood smears from patients with a fever were reviewed to evaluate the quality of blood smears.Laboratory detection of malaria at the provincial and prefectural(city)level was compared to that at the county level(qualitative detection,coincidence of insect species)in Yunnan Province in 2017. Results Cases of malaria that were reported in the province in 2017 came from 13 municipalities.Cases were reviewed at a rate of 98.25%(337/343),reflecting a 3.41%increase from 2015 and a 2.55%increase from 2016.Three hundred and thirty-six blood samples were microscopically examined in the laboratory at the provincial level.The positive concordance rate was 94.05%(316/336),which was 1.1%lower than the rate in 2016(95.1%).The coincidence of insect species was 96.52%(305/316),which was 4.57% higher than the coincidence in 2016(92.3%).Of the 1,505 patients from whom negative blood smears were obtained,100.33%(1,505/1,500)completed the planned treatment,and the negative concordance rate was100%.Three hundred and forty-one blood samples on filter paper were tested at the provincial level.The concordance of malaria detection at the county level was 96.77%(330/341),and the coincidence of insect species was 96.01%(313/326).The concordance increased 1.76%from 2016 and the coincidence of insect species increased 5.16%.At the sametime,326 positive blood smears and blood samples on filter paper were tested.Microscopic examination at the provincial level and testing for malaria genes agreed for 313 of those smears and samples.The concordance rate of the two methods was 96.01%.Nine(69.23%)of 13 smears and samples where microscopic examination and gene testing disagreed were misdiagnosed as a single infection.In those 9 smears and samples,malaria was not detected by microscopy but malaria genes were detected.A total of 1,841 blood smears was analyzed in 2017.The total score for blood smears leading to a report of malaria was 80.09,and the overall rate of successful identification was 59.82%(201/336).The total score for negative blood smears was 80.45.The preparation and staining of blood smears and the cleanliness of slides were basically the same as in 2016.There were no differences between blood smears leading to a report of malaria and negative blood smears(P>0.05). Conclusion In 2017,the level of detection and quality of laboratory diagnosis of malaria improved overall in Yunnan Province in comparison to previous years.In this critical stage of malaria elimination,however,laboratories should use a combination of methods to perform malaria testing,continue to enhance the proficiency training of technicians and control quality,and improve the ability of prevention and control organizations to diagnose malaria.
引文
[1]张丽,周水森,丰俊,等.2014年全国疟疾疫情分析[J].中国寄生虫学与寄生虫病杂志,2015,33(5):319-26.
[2]魏春,杜龙飞,赵晓涛,等.2011-2013年云南省疟疾疫情分析[J].中国血吸虫病防治杂志,2016,28(1):26-9.
[3]尹授钦,丰俊,夏尚,等.2012-2014年云南省边境地区输入性疟疾病例流行特征分析[J].中国血吸虫病防治杂志,2016,28(3):252-7.
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[5]World Health Organization.Guidelines for the treatment of malaria:Diagnosis of malaria(2010)[S].Geneva:World Health Organization,2010.
[6]Snounor GSS,Viriyakosol XP,Zhu W,et al.High sensitivity of detection of human malaria parasites by the use of nested polymerase chain reaction[J].Mol Biochem Parastol,1993,61:315-20.
[7]Stephanie PJ,Norman JP,Manphet VX,et al.PCR as a confirmatory technique for laboratory diagnosis of malaria[J].J Clin Mecrobiol,2006,44(3):1087-89.
[8]中华人民共和国卫生部,中华人民共和国卫生行业标准:疟疾诊断标准(WS259-2006)[S].中华人民共和国卫生部公报,2006
[9]朱垚吉,邓艳,毛祥华,等.不同感染疟原虫株的18SsRNA基因同源性分析[J].中国病原生物学杂志,2014,9(4):331-34.
[10]Pakalapati D,Garg S,Middha S,et al.Comparative evaluation of microscopy,OptiMAL(?)and 18SrRNA gene based multiplex PCR for detection of Plasmodium falciparum&Plasmodium vivax from field isolates of Bikaner,India[J].Asian Pac J Trop Med,2013,6(5):346-51.
[11]杨维中,周晓农.中国在疟疾消除阶段面临的新挑战[J].中华檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿预防医学杂志,2016,50(4):289-91.
[12]董莹,毛祥华,陈梦妮,等.2012-2014年云南省疟疾实验室诊断质量分析[J].中国寄生虫学与寄生虫病杂志,2015,33(3):191-5.
[13]雷蕾,夏志贵,李志宏,等.2012-2015年江西省输入性疟疾病例诊断和报告情况分析[J].中国寄生虫学与寄生虫病杂志,2017,35(1):80-5.
[14]邓艳,董莹,徐艳春,等.2015-2016年云南省疟疾实验室诊断质量及影响因素分析[J].中国人兽共患病学报,2018,34(4):337-42.
[15]陈梦妮,毛祥华,邓艳,等.云南省疟疾疫情病例疟原虫镜检疑难形态的鉴定[J].中国病原生物学杂志,2017,12(3):227-32.
[16]董莹,陈梦妮,徐艳春.免疫快速诊断卡检出疟原虫感染的准确性荟萃分析[J].中国病原生物学杂志,2016,11(4):353-8.
[17]佘丹娅,吴家红,卢丽丹,等.2014-2016年贵州省市(州)级疟疾实验室检测能力的评价[J].中国寄生虫学与寄生虫病杂志,2017,35(5):466-71.
[18]吴小红,许国君,郁涛,等.四川省网报疟疾病例血片镜检复核与分析[J].寄生虫病与感染性疾病,2016,14(3):159-62.
[19]武书敏,陈晓霞,李雪红,等.成安县疟疾中心镜检站抽检血片的质量分析[J].医学动物防制,2015,31(11):1286-88.
[20]金行一,朱素娟,徐卫民,等.2014-2016年杭州市疟疾实验室诊断质量分析[J].中国卫生检验杂志,2017,27(19):2867-69.
[21]尹建海,燕贺,李美,等.疟疾诊断参比实验室:疟原虫显微镜检测能力外部评估结果分析[J].国际医学寄生虫病杂志,2015,42(3):173-5.
[2]魏春,杜龙飞,赵晓涛,等.2011-2013年云南省疟疾疫情分析[J].中国血吸虫病防治杂志,2016,28(1):26-9.
[3]尹授钦,丰俊,夏尚,等.2012-2014年云南省边境地区输入性疟疾病例流行特征分析[J].中国血吸虫病防治杂志,2016,28(3):252-7.
[4]World Health Organization.Guidelines for the treatment of malaria:Diagnosis of malaria(2010)[M].Geneva:World Health Organization,2010.
[5]World Health Organization.Guidelines for the treatment of malaria:Diagnosis of malaria(2010)[S].Geneva:World Health Organization,2010.
[6]Snounor GSS,Viriyakosol XP,Zhu W,et al.High sensitivity of detection of human malaria parasites by the use of nested polymerase chain reaction[J].Mol Biochem Parastol,1993,61:315-20.
[7]Stephanie PJ,Norman JP,Manphet VX,et al.PCR as a confirmatory technique for laboratory diagnosis of malaria[J].J Clin Mecrobiol,2006,44(3):1087-89.
[8]中华人民共和国卫生部,中华人民共和国卫生行业标准:疟疾诊断标准(WS259-2006)[S].中华人民共和国卫生部公报,2006
[9]朱垚吉,邓艳,毛祥华,等.不同感染疟原虫株的18SsRNA基因同源性分析[J].中国病原生物学杂志,2014,9(4):331-34.
[10]Pakalapati D,Garg S,Middha S,et al.Comparative evaluation of microscopy,OptiMAL(?)and 18SrRNA gene based multiplex PCR for detection of Plasmodium falciparum&Plasmodium vivax from field isolates of Bikaner,India[J].Asian Pac J Trop Med,2013,6(5):346-51.
[11]杨维中,周晓农.中国在疟疾消除阶段面临的新挑战[J].中华檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿檿预防医学杂志,2016,50(4):289-91.
[12]董莹,毛祥华,陈梦妮,等.2012-2014年云南省疟疾实验室诊断质量分析[J].中国寄生虫学与寄生虫病杂志,2015,33(3):191-5.
[13]雷蕾,夏志贵,李志宏,等.2012-2015年江西省输入性疟疾病例诊断和报告情况分析[J].中国寄生虫学与寄生虫病杂志,2017,35(1):80-5.
[14]邓艳,董莹,徐艳春,等.2015-2016年云南省疟疾实验室诊断质量及影响因素分析[J].中国人兽共患病学报,2018,34(4):337-42.
[15]陈梦妮,毛祥华,邓艳,等.云南省疟疾疫情病例疟原虫镜检疑难形态的鉴定[J].中国病原生物学杂志,2017,12(3):227-32.
[16]董莹,陈梦妮,徐艳春.免疫快速诊断卡检出疟原虫感染的准确性荟萃分析[J].中国病原生物学杂志,2016,11(4):353-8.
[17]佘丹娅,吴家红,卢丽丹,等.2014-2016年贵州省市(州)级疟疾实验室检测能力的评价[J].中国寄生虫学与寄生虫病杂志,2017,35(5):466-71.
[18]吴小红,许国君,郁涛,等.四川省网报疟疾病例血片镜检复核与分析[J].寄生虫病与感染性疾病,2016,14(3):159-62.
[19]武书敏,陈晓霞,李雪红,等.成安县疟疾中心镜检站抽检血片的质量分析[J].医学动物防制,2015,31(11):1286-88.
[20]金行一,朱素娟,徐卫民,等.2014-2016年杭州市疟疾实验室诊断质量分析[J].中国卫生检验杂志,2017,27(19):2867-69.
[21]尹建海,燕贺,李美,等.疟疾诊断参比实验室:疟原虫显微镜检测能力外部评估结果分析[J].国际医学寄生虫病杂志,2015,42(3):173-5.