评估三种新型寄生虫乳酸脱氢酶（泛 pLDH）检测方法用于诊断非复杂性疟疾。

Assessment of three new parasite lactate dehydrogenase (pan-pLDH) tests for diagnosis of uncomplicated malaria.

作者信息

Fogg Carole, Twesigye Rogers, Batwala Vincent, Piola Patrice, Nabasumba Carolyn, Kiguli James, Mutebi Frederick, Hook Christa, Guillerm Martine, Moody Anthony, Guthmann Jean-Paul

机构信息

Epicentre, 8 rue Saint Sabin, 75011, Paris, France.

出版信息

Trans R Soc Trop Med Hyg. 2008 Jan;102(1):25-31. doi: 10.1016/j.trstmh.2007.09.014. Epub 2007 Nov 26.

DOI:10.1016/j.trstmh.2007.09.014

PMID:18031779

Abstract

A study to assess the diagnostic capabilities of three parasite lactate dehydrogenase (pan-pLDH) tests, Vistapan), Carestart and Parabank), was conducted in Uganda. An HRP2 test, Paracheck-Pf), and a Giemsa-stained blood film were performed with the pLDH tests for outpatients with suspected malaria. In total, 460 subjects were recruited: 248 with positive blood films and 212 with negative blood films. Plasmodium falciparum was present in 95% of infections. Sensitivity above 90% was shown by two pLDH tests, Carestart (95.6%) and Vistapan (91.9%), and specificity above 90% by Parabank (94.3%) and Carestart (91.5%). Sensitivity decreased with low parasitaemia (chi(2) trend, P<0.001); however, all tests achieved sensitivity >90% with parasitaemia > or =100/microl. All tests had good inter-reader reliability (kappa>0.95). Two weeks after diagnosis, 4-10% of pLDH tests were still positive compared with 69.7% of the HRP2 tests. All tests had similar ease of use. In conclusion, two pLDH tests performed well in diagnosing P. falciparum malaria, and all pLDH tests became negative after treatment more quickly than the HRP2. Therefore the rapid test of choice for use with artemisinin-combination therapies in this area would be one of these new pLDH tests.

摘要

在乌干达开展了一项评估三种疟原虫乳酸脱氢酶（泛pLDH）检测试剂（Vistapan、Carestart和Parabank）诊断能力的研究。对疑似疟疾的门诊患者，除进行pLDH检测外，还开展了HRP2检测（Paracheck - Pf）和吉姆萨染色血涂片检查。总共招募了460名受试者：248名血涂片阳性，212名血涂片阴性。95%的感染病例中存在恶性疟原虫。两种pLDH检测试剂Carestart（95.6%）和Vistapan（91.9%）的灵敏度高于90%，Parabank（94.3%）和Carestart（91.5%）的特异性高于90%。低疟原虫血症时灵敏度降低（卡方趋势，P<0.001）；然而，当疟原虫血症≥100/μl时，所有检测的灵敏度均>90%。所有检测在不同阅片者间的可靠性良好（kappa>0.95）。诊断两周后，4 - 10%的pLDH检测仍为阳性，而HRP2检测的这一比例为69.7%。所有检测的易用性相似。总之，两种pLDH检测试剂在诊断恶性疟原虫疟疾方面表现良好，且所有pLDH检测在治疗后比HRP2更快转阴。因此，该地区用于青蒿素联合疗法的快速检测的首选将是这些新型pLDH检测试剂之一。