麻疹疑似病例血清学与病原学检测结果比较

目的 分析麻疹疑似病例血清学和病原学的检测结果，比较两种检测方法，为麻疹的早期诊断提供实验室支持。方法 同时采集2017‒2018年北京市海淀区麻疹疑似病例的血清和咽拭子标本，用酶联免疫吸附试验（ELISA）方法检测血清中的麻疹IgM抗体，用荧光定量PCR（Real-time PCR）方法检测咽拭子标本中的麻疹病毒核酸。结果 血清IgM抗体检测阳性率为11.54%，Real-time PCR法检测阳性率为44.23%，其检测阳性率显著高于血清检测阳性率，差异有统计学意义（2=13.82，P0.05）。血清学检测敏感性为25.00%，病原学检测敏感性为95.83%，两种检测方法的阳性符合率为21.74%，阴性符合率为96.55%，总符合率为63.46%。ELISA和Real-time PCR法对有免疫史的病例检测阳性率分别为18.75%和37.50%，两种检测方法的阳性率差异无统计学意义（2=1.39，P>0.05）；对无免疫史或免疫史不详病例检测的阳性率分别为8.30%和47.20%，两种检测方法的阳性率差异有统计学意义（2=13.57，P<0.01）。结论 Real-time PCR方法检测的阳性率和灵敏度均高于血清学检测方法，可以在日常检测工作中作为常规方法推广，无论采用哪种检测方法，应在出疹3 d内采集样本。

Comparative analysis on results of serological and etiological detections ofmeasles virus from suspected cases in Haidian district of Beijing during 2017 - 2018

Objective To analyze the results of serological and etiological detections of measles virus from suspected cases, compare the two methods, and provide laboratory support for early diagnosis of measles. Methods Oropharyngeal swabs and blood samples were collected from the suspected cases in Haidian district of Beijing during 2017–2018. The IgM antibody of measles virus in serum were detected by using Enzyme-Linked Immuno Sorbent Assay (ELISA), and the nucleic acids of measles virus were detected by using Real-time PCR. Results The detection rate of measles virus by RT-PCR (44.23%) was higher than that by IgM antibody detection with ELISA (11.54%), with significant difference (2=13.82, P0.05). The sensitivity of ELISA was 25.00% and that of Real-time PCR was 95.83%. The positive coincidence rate was 21.74%, the negative coincidence rate was 96.55%, while total coincidence rate was 63.46%. There was no significant difference in the positive rate between ELISA (18.75%) and Quantitative Real-time PCR (37.50%) for the suspected cases with immunization history (2=1.39, P>0.05), but for the cases with no immunization history or unspecified history (8.30% by ELISA vs 47.20% by Real-time PCR, 2=13.57, P<0.01). Conclusion The positive rate and sensitivity of Real-time PCR are higher than those of ELISA respectively, which should be recommended as a conventional method in routine detection. Oropharyngeal swabs and blood samples should be collected within 3 days from the breakout of measles rash as much as possible.