Lefford M J, Hunegnaw M, Siwik E
Department of Immunology and Microbiology, Wayne State University School of Medicine, Detroit, Michigan 48201.
Int J Lepr Other Mycobact Dis. 1991 Sep;59(3):432-40.
An ELISA has been used to measure IgM antibodies to phenolic glycolipid-I (PGL-I) in previously undiagnosed patients who were suspected of leprosy on purely clinical grounds. The certainty of clinical diagnosis was classified as either "firm" or "indefinite." Leprosy was confirmed in 133 of 161 patients on the basis of positive slit-skin smears and/or skin and/or nerve histopathology. All 58 patients with multibacillary leprosy (BB, BL, or LL) were correctly diagnosed clinically, as were 50 of 54 patients (93%) with a firm diagnosis of BT or TT leprosy. The firm clinical diagnoses were more accurate than either the slit-skin smear or ELISA data. However, there were 44 patients (27% of total), designated "rule out leprosy" (RO), for whom the clinical diagnosis was indefinite. The clinical suspicion of leprosy (RO) was correct in only 24 (55%) of these patients who had BT leprosy. The slit-skin smears were positive in only 20% of these patients compared to 50% for the ELISA. It was concluded that the PGL-I IgM ELISA may have its greatest diagnostic confirmatory value in paucibacillary disease because paucibacillary leprosy comprises the major source of clinical diagnostic difficulty.
酶联免疫吸附测定（ELISA）已用于检测此前未经诊断、仅基于临床症状疑似麻风病患者血清中针对酚糖脂-I（PGL-I）的IgM抗体。临床诊断的确定性分为“明确”或“不明确”。161例患者中，133例经阳性皮肤刮片和/或皮肤及/或神经组织病理学检查确诊为麻风病。所有58例多菌型麻风病（BB、BL或LL）患者临床诊断均正确，54例确诊为BT或TT型麻风病的患者中，50例（93%）临床诊断正确。明确的临床诊断比皮肤刮片或ELISA检测数据更准确。然而，有44例患者（占总数的27%）被判定为“排除麻风病”（RO），其临床诊断不明确。在这些疑似BT型麻风病的患者中，只有24例（55%）临床怀疑正确。这些患者中皮肤刮片阳性率仅为20%，而ELISA检测阳性率为50%。研究得出结论，PGL-I IgM ELISA在少菌型疾病中可能具有最大的诊断确认价值，因为少菌型麻风病是临床诊断困难的主要来源。
