Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Curr Opin Pediatr. 2011 Feb;23(1):91-7. doi: 10.1097/MOP.0b013e328341ebd9.
The 2009 H1N1 pandemic focused attention on the speed and accuracy of influenza diagnostic methods. This review provides an update on current tests and new developments.
Widely used rapid antigen tests and immunofluorescence tests were generally less sensitive for 2009 H1N1 influenza than for seasonal influenza. In addition, marked variability was reported for the same tests in different settings and patient groups. The advantages of molecular testing gained wide recognition, namely high sensitivity, speed compared with culture, ability to assess viral load and to identify subtype. Although adoption of influenza molecular testing can be expected to accelerate, immunoassays and rapid cultures performed on site retain advantages for many facilities. Falsely negative results were seen with all methods, especially for samples collected very early or late.
Influenza diagnostic test performance can be adversely affected by viral genetic and antigenic changes and should be re-assessed annually. Variability in sensitivity and specificity of the same test in different settings highlights the need for each laboratory to ensure optimal procedures and work with clinicians to improve sample quality. Manufacturers have been motivated to improve immunoassays and develop simpler and faster multiplex molecular tests, hopefully in advance of the next pandemic.
2009 年 H1N1 大流行引起了人们对流感诊断方法的速度和准确性的关注。本综述介绍了当前的检测方法和新的进展。
广泛使用的快速抗原检测和免疫荧光检测对 2009 年 H1N1 流感的敏感性通常低于季节性流感。此外，在不同的环境和患者群体中，相同的检测方法的报道显示出明显的差异。分子检测的优势得到了广泛的认可，即高灵敏度、与培养相比的速度、评估病毒载量和识别亚型的能力。尽管预计流感分子检测的采用会加速，但对于许多医疗机构来说，现场进行的免疫检测和快速培养仍然具有优势。所有方法都可能出现假阴性结果，尤其是在采集样本非常早或很晚的情况下。
流感诊断测试的性能可能会受到病毒遗传和抗原变化的不利影响，因此应每年重新评估。同一检测方法在不同环境中的敏感性和特异性的差异突出表明，每个实验室都需要确保最佳的检测程序，并与临床医生合作，以提高样本质量。制造商已经有动力改进免疫检测，并开发更简单、更快的多重分子检测方法，希望能在下次大流行之前实现。
