中华预防医学杂志
中華預防醫學雜誌
중화예방의학잡지
CHINESE JOURNAL OF
2011年
10期
916-919
,共4页
李燕%梁彩云%高凯%韩志刚%罗碧莲%徐慧芳
李燕%樑綵雲%高凱%韓誌剛%囉碧蓮%徐慧芳
리연%량채운%고개%한지강%라벽련%서혜방
HIV抗体%随访研究%辅助诊断%生物学因素
HIV抗體%隨訪研究%輔助診斷%生物學因素
HIV항체%수방연구%보조진단%생물학인소
HIV antibodies%Follow-up studies%Auxiliary diagnosis%Biological factor
目的 探讨HIV抗体不确定患者随访转归、辅助诊断方法及导致出现HIV抗体不确定结果的有关生物学因素。方法 按照《全国艾滋病检测技术规范(2009) ，对笔者所在实验室2005-2009年经Western blotting检测结果为HIV抗体不确定的269例患者进行随访检测，同时以核酸和p24抗原检测为辅助诊断，检测乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)、梅毒螺旋体(TP)、人类嗜T细胞病毒(HTLV)Ⅰ型和Ⅱ型的感染状况及抗核抗体(ANA)、甲胎蛋白(AFP)在血液中的含量，并与筛查阳性但Western blotting确认阴性患者的样本进行比较。结果 共有73例HIV抗体不确定者成功随访，其中25例在随访中抗体转阳，确认感染HIV；48例抗体转阴，排除HIV感染。对于随访期间抗体转阳的患者，当回访检测时间超过1周后，任意时间段回访检测的抗体阳转率均为100.00％。HIV抗体不确定患者Western blotting带型主要集中在p24和gp160，抗体转阳组和抗体转阴组带型分布不同。核酸检测与Western blotting检测方法的一致率及灵敏度均高于90.00％，且均高于p24抗原的69.09％( 38/55)和27.27％( 6/22)，差异有统计学意义（x2一致率=6.875，x2灵敏度=18.893，P值均＜0.05）。抗体转阴的HIV抗体不确定患者ANA、AFP阳性率分别为20.83％(1 0/28)、6.25％ (3/48)，高于筛查阳性Western blotting确认阴性的患者（均为0.00％），差异有统计学意义（x2ANA= 19.430，x2AFP =5.520，P值均＜0.05）；但两组HBV、HCV、HTLV和TP感染情况类似。结论 对HIV抗体不确定进行随访有利于患者的及时诊断。作为辅助诊断，核酸检测比p24抗原检测具有更强的应用价值；患者体内ANA、AFP水平升高可能是致HIV抗体不确定的非特异性反应的因素。
目的 探討HIV抗體不確定患者隨訪轉歸、輔助診斷方法及導緻齣現HIV抗體不確定結果的有關生物學因素。方法 按照《全國艾滋病檢測技術規範(2009) ，對筆者所在實驗室2005-2009年經Western blotting檢測結果為HIV抗體不確定的269例患者進行隨訪檢測，同時以覈痠和p24抗原檢測為輔助診斷，檢測乙型肝炎病毒(HBV)、丙型肝炎病毒(HCV)、梅毒螺鏇體(TP)、人類嗜T細胞病毒(HTLV)Ⅰ型和Ⅱ型的感染狀況及抗覈抗體(ANA)、甲胎蛋白(AFP)在血液中的含量，併與篩查暘性但Western blotting確認陰性患者的樣本進行比較。結果 共有73例HIV抗體不確定者成功隨訪，其中25例在隨訪中抗體轉暘，確認感染HIV；48例抗體轉陰，排除HIV感染。對于隨訪期間抗體轉暘的患者，噹迴訪檢測時間超過1週後，任意時間段迴訪檢測的抗體暘轉率均為100.00％。HIV抗體不確定患者Western blotting帶型主要集中在p24和gp160，抗體轉暘組和抗體轉陰組帶型分佈不同。覈痠檢測與Western blotting檢測方法的一緻率及靈敏度均高于90.00％，且均高于p24抗原的69.09％( 38/55)和27.27％( 6/22)，差異有統計學意義（x2一緻率=6.875，x2靈敏度=18.893，P值均＜0.05）。抗體轉陰的HIV抗體不確定患者ANA、AFP暘性率分彆為20.83％(1 0/28)、6.25％ (3/48)，高于篩查暘性Western blotting確認陰性的患者（均為0.00％），差異有統計學意義（x2ANA= 19.430，x2AFP =5.520，P值均＜0.05）；但兩組HBV、HCV、HTLV和TP感染情況類似。結論 對HIV抗體不確定進行隨訪有利于患者的及時診斷。作為輔助診斷，覈痠檢測比p24抗原檢測具有更彊的應用價值；患者體內ANA、AFP水平升高可能是緻HIV抗體不確定的非特異性反應的因素。
목적 탐토HIV항체불학정환자수방전귀、보조진단방법급도치출현HIV항체불학정결과적유관생물학인소。방법 안조《전국애자병검측기술규범(2009) ，대필자소재실험실2005-2009년경Western blotting검측결과위HIV항체불학정적269례환자진행수방검측，동시이핵산화p24항원검측위보조진단，검측을형간염병독(HBV)、병형간염병독(HCV)、매독라선체(TP)、인류기T세포병독(HTLV)Ⅰ형화Ⅱ형적감염상황급항핵항체(ANA)、갑태단백(AFP)재혈액중적함량，병여사사양성단Western blotting학인음성환자적양본진행비교。결과 공유73례HIV항체불학정자성공수방，기중25례재수방중항체전양，학인감염HIV；48례항체전음，배제HIV감염。대우수방기간항체전양적환자，당회방검측시간초과1주후，임의시간단회방검측적항체양전솔균위100.00％。HIV항체불학정환자Western blotting대형주요집중재p24화gp160，항체전양조화항체전음조대형분포불동。핵산검측여Western blotting검측방법적일치솔급령민도균고우90.00％，차균고우p24항원적69.09％( 38/55)화27.27％( 6/22)，차이유통계학의의（x2일치솔=6.875，x2령민도=18.893，P치균＜0.05）。항체전음적HIV항체불학정환자ANA、AFP양성솔분별위20.83％(1 0/28)、6.25％ (3/48)，고우사사양성Western blotting학인음성적환자（균위0.00％），차이유통계학의의（x2ANA= 19.430，x2AFP =5.520，P치균＜0.05）；단량조HBV、HCV、HTLV화TP감염정황유사。결론 대HIV항체불학정진행수방유리우환자적급시진단。작위보조진단，핵산검측비p24항원검측구유경강적응용개치；환자체내ANA、AFP수평승고가능시치HIV항체불학정적비특이성반응적인소。
Objective To explore the follow-up visit, outcome and auxiliary diagnosis method on the cases with indeterminate antibody level measured by Western blotting as well as the related biological factors. Methods The cases with indeterminate result were followed up according to the National Guideline for Detection of HIV/AIDS(2009) and samples were collected for HIV antibody detection, p24 antigen and nucleic acid were detected as a supplementary diagnosis at the same time. The samples were also be detected for HBV,HCV,TP,HTLV- Ⅰ / Ⅱ ,ANA,and AFP,and the results were compared to that of screened positive and confirmed negative cases. Results A total of 73 were followed up successfully and taken a second HIV test ,25 cases were tested positive and 48 were tested negative for HIV during the follow-up period. For the 25 HIV positive cases,the HIV seroconversion rate was 100. 00％ at any time point when the interval between the first and returning detection was longer than 1 week. The major Western blotting bands for the cases with indeterminate result were p24 and gp160 and it was different between HIV positive and negative cases in Western blotting band profiles. The consistency and sensitivity of nucleic acid detection were higher than 90. 00％, and were higher than that of p24 antigen (69. 09％ ( 38/55 ) and 27. 27％ (6/22))(x2consistency= 6. 875, x2sensitivity = 18. 893, P ＜ 0. 05 ). The positive rates of A NA and AFP of indeterminate cases excluded from HIV infection were 20. 83％ (10/28) and 6. 25％ (3/48) and higher than that of screened positive and confirmed negative cases (0. 00％ ), the difference had statistic significance ( x2ANA = 19. 430, x2AFP = 5. 520,P ＜ 0. 05). Conclusion It is critical to get timely diagnosis for the indeterminate cases according to the new national guideline for detection of HIV/AIDS. Nucleic acid detection has higher application value as auxiliary diagnosis for HIV infection than p24 antigen. The increased levels of ANA and AFP may be the factors resulting in the nonspecific indeterminate results.
