Paris L, Touafek F, Elghouzzi M H, Chérif S, Mazier D
Laboratoire de parasitologie-mycologie, groupe hospitalier Pitié-Salpêrière, 47, boulevard de l'Hôpital, F-75013 Paris, France.
Bull Soc Pathol Exot. 2009 Dec;102(5):319-25.
The diagnosis of Chagas disease during the chronic phase is based on serology. Outside South America the use of two methods is recommended by WHO. A third method must be available for inconclusive results but there is no gold standard. A pilot study of screening in 254 Bolivian people living in the Paris area (France) was made. Serological study was performed using IIF and three Elisa, Elisa Cruzi (BioMérieux Brésil), BioElisa Chagas (Bio-kit), and Chagatest Elisa recombinante v. 3.0 (Wiener Lab). 165 patients were negative, 69 positive and 20 inconclusive. PCR-based assays appear to have a better sensitivity than parasitological methods, but not more than 70% that do not justify their use for primary testing. There are no standardized and commercial assays. The primer pairs based on the nuclear sequence TCZ1-TCZ2 seems to be the more specific (no cross reaction with others Trypanosomatidae) and the most sensitive with the strains of the two lineage of Trypanosoma cruzi. PCR would have a role in inconclusive serological cases or in the evaluation of treatment failure.
恰加斯病慢性期的诊断基于血清学检测。在世卫组织的建议下，南美以外地区推荐使用两种检测方法。若检测结果不明确，则必须采用第三种方法，但目前尚无金标准检测方法。我们对居住在法国巴黎地区的254名玻利维亚人进行了筛查试点研究。血清学检测采用间接免疫荧光法（IIF）和三种酶联免疫吸附测定法（ELISA），分别为克鲁兹利什曼原虫ELISA法（BioMérieux巴西公司）、恰加斯病生物ELISA法（Bio-kit公司）以及重组3.0版恰加斯病ELISA检测法（Wiener实验室）。165名患者检测结果为阴性，69名阳性，20名结果不明确。基于聚合酶链反应（PCR）的检测方法似乎比寄生虫学检测方法具有更高的灵敏度，但灵敏度不超过70%，因此不适合用于初筛。目前尚无标准化的商业检测方法。基于核序列TCZ1-TCZ2的引物对似乎具有更高的特异性（与其他锥虫科无交叉反应），并且对克氏锥虫两个谱系的菌株最为敏感。PCR检测在血清学检测结果不明确的病例或治疗失败评估中具有一定作用。
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