严重急性呼吸综合征诊断实验室检测解读：多伦多的经验

Interpretation of diagnostic laboratory tests for severe acute respiratory syndrome: the Toronto experience.

作者信息

Tang Patrick, Louie Marie, Richardson Susan E, Smieja Marek, Simor Andrew E, Jamieson Frances, Fearon Margaret, Poutanen Susan M, Mazzulli Tony, Tellier Raymond, Mahony James, Loeb Mark, Petrich Astrid, Chernesky Max, McGeer Allison, Low Donald E, Phillips Elizabeth, Jones Steven, Bastien Nathalie, Li Yan, Dick Daryl, Grolla Allen, Fernando Lisa, Booth Timothy F, Henry Bonnie, Rachlis Anita R, Matukas Larissa M, Rose David B, Lovinsky Reena, Walmsley Sharon, Gold Wayne L, Krajden Sigmund

机构信息

University of Toronto , Ont.

出版信息

CMAJ. 2004 Jan 6;170(1):47-54.

DOI:

PMID:14707219

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC305313/

Abstract

BACKGROUND

An outbreak of severe acute respiratory syndrome (SARS) began in Canada in February 2003. The initial diagnosis of SARS was based on clinical and epidemiological criteria. During the outbreak, molecular and serologic tests for the SARS-associated coronavirus (SARS-CoV) became available. However, without a "gold standard," it was impossible to determine the usefulness of these tests. We describe how these tests were used during the first phase of the SARS outbreak in Toronto and offer some recommendations that may be useful if SARS returns.

METHODS

We examined the results of all diagnostic laboratory tests used in 117 patients admitted to hospitals in Toronto who met the Health Canada criteria for suspect or probable SARS. Focusing on tests for SARS-CoV, we attempted to determine the optimal specimen types and timing of specimen collection.

RESULTS

Diagnostic test results for SARS-CoV were available for 110 of the 117 patients. SARS-CoV was detected by means of reverse-transcriptase polymerase chain reaction (RT-PCR) in at least one specimen in 59 (54.1%) of 109 patients. Serologic test results of convalescent samples were positive in 50 (96.2%) of 52 patients for whom paired serum samples were collected during the acute and convalescent phases of the illness. Of the 110 patients, 78 (70.9%) had specimens that tested positive by means of RT-PCR, serologic testing or both methods. The proportion of RT-PCR test results that were positive was similar between patients who met the criteria for suspect SARS (50.8%, 95% confidence interval [CI] 38.4%-63.2%) and those who met the criteria for probable SARS (58.0%, 95% CI 44.2%-70.7%). SARS-CoV was detected in nasopharyngeal swabs in 33 (32.4%) of 102 patients, in stool specimens in 19 (63.3%) of 30 patients, and in specimens from the lower respiratory tract in 10 (58.8%) of 17 patients.

INTERPRETATION

These findings suggest that the rapid diagnostic tests in use at the time of the initial outbreak lack sufficient sensitivity to be used clinically to rule out SARS. As tests for SARS-CoV continue to be optimized, evaluation of the clinical presentation and elucidation of a contact history must remain the cornerstone of SARS diagnosis. In patients with SARS, specimens taken from the lower respiratory tract and stool samples test positive by means of RT-PCR more often than do samples taken from other areas.

摘要

背景

2003年2月，加拿大爆发了严重急性呼吸综合征（SARS）。SARS的初步诊断基于临床和流行病学标准。在疫情爆发期间，出现了针对SARS相关冠状病毒（SARS-CoV）的分子和血清学检测方法。然而，由于缺乏“金标准”，无法确定这些检测方法的有效性。我们描述了在多伦多SARS疫情第一阶段这些检测方法的使用情况，并提出了一些如果SARS再次出现可能有用的建议。

方法

我们检查了多伦多符合加拿大卫生部疑似或可能SARS标准的117名住院患者所进行的所有诊断实验室检测结果。重点关注SARS-CoV检测，我们试图确定最佳的标本类型和标本采集时间。

结果

117名患者中有110名获得了SARS-CoV的诊断检测结果。109名患者中，有59名（54.1%）至少在一份标本中通过逆转录聚合酶链反应（RT-PCR）检测出SARS-CoV。在疾病急性期和恢复期采集配对血清样本的52名患者中，恢复期样本的血清学检测结果有50名（96.2%）呈阳性。在这110名患者中，78名（70.9%）的标本通过RT-PCR、血清学检测或两种方法检测呈阳性。符合疑似SARS标准的患者与符合可能SARS标准的患者相比，RT-PCR检测结果呈阳性的比例相似（分别为50.8%，95%置信区间[CI]38.4%-63.2%和58.0%，95%CI 44.2%-70.7%）。102名患者中有33名（32.4%）在鼻咽拭子中检测出SARS-CoV，30名患者中有19名（63.3%）在粪便标本中检测出，17名患者中有10名（58.8%）在下呼吸道标本中检测出。