Wagner Bettina, Freer Heather, Rollins Alicia, Erb Hollis N, Lu Zhao, Gröhn Yrjo
Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, NY, USA.
Vet Immunol Immunopathol. 2011 Dec 15;144(3-4):374-81. doi: 10.1016/j.vetimm.2011.08.005. Epub 2011 Aug 17.
Lyme disease is a zoonotic, vector-borne disease and occurs in mammals including horses. The disease is induced by infection with spirochetes of the Borrelia burgdorferi sensu lato group. Infection of mammalian hosts requires transmission of spirochetes by infected ticks during tick bites. Lyme disease diagnosis is based on clinical signs, possible exposure to infected ticks, and antibody testing which is traditionally performed by ELISA and Western blotting (WB). This report describes the development and validation of a new fluorescent bead-based multiplex assay for the detection of antibodies to B. burgdorferi outer surface protein A (OspA), OspC and OspF antigens in horse serum. Testing of 562 equine sera was performed blindly and in parallel by using WB and the new multiplex assay. Because a true gold standard is missing for Lyme antibody testing, we performed and compared different statistical approaches to validate the new Lyme multiplex assay. One approach was to use WB results as a 'relative gold standard' in ROC-curve and likelihood-ratio analyses of the new test. Cut-off values and interpretation ranges of the multiplex assay were established by the analysis. The second statistical approach used a Bayesian model for the calculation of diagnostic sensitivities and specificities of the multiplex assay. The Bayesian analysis takes into consideration that no true gold standard exists for detecting antibodies to B. burgdorferi and estimated sensitivities and specificities of both tests that were compared. Therefore, the Bayesian analysis also resulted in an evaluation of diagnostic sensitivity and specificity of WB. Overall, the new assay was characterized by low background values and a wide dynamic quantification range for the detection of antibodies to OspA, OspC and OspF antigens of B. burgdorferi. The diagnostic sensitivity and specificity for the OspA bead-based assay were calculated as 49% and 85%, respectively, and by a standard ROC curve analysis only because the Bayesian model could not be run on this parameter. The Bayesian-derived diagnostic sensitivities of the OspC and OspF assays were 80% and 86%, respectively. For comparison, the Bayesian-derived estimates for WB resulted in sensitivities of 72% for OspC and 80% for OspF. The Bayesian diagnostic specificities of the multiplex assay were 79% and 69% for OspC and OspF, respectively. WB analysis had specificities of 92% for OspC and 77% for OspF. Although the analysis of a new assay in the absence of a true gold standard remains challenging, the approach used here can help to address this problem when new technologies and traditionally used test standards differ significantly in their analytical sensitivities, which consequently causes problems in the calculation of diagnostic sensitivity and sensitivity values for the new assay. In summary, the new multiplex assay for the detection of antibodies to B. burgdorferi OspA, OspC and OspF antigens in horse serum has improved analytical and diagnostic sensitivities compared to WB analysis. Multiplex analysis is a valuable quantitative tool that simultaneously detects antibodies indicative for natural infection with and/or vaccination against the Lyme pathogen.
莱姆病是一种人畜共患的媒介传播疾病,可发生于包括马在内的哺乳动物。该疾病由伯氏疏螺旋体狭义组的螺旋体感染引起。哺乳动物宿主的感染需要在蜱叮咬期间由受感染的蜱传播螺旋体。莱姆病的诊断基于临床症状、可能接触受感染的蜱以及抗体检测,传统上通过酶联免疫吸附测定(ELISA)和免疫印迹法(WB)进行。本报告描述了一种基于荧光微球的新型多重检测方法的开发和验证,该方法用于检测马血清中针对伯氏疏螺旋体表面蛋白A(OspA)、OspC和OspF抗原的抗体。使用WB和新型多重检测方法对562份马血清进行了盲法平行检测。由于莱姆抗体检测缺乏真正的金标准,我们采用并比较了不同的统计方法来验证新型莱姆多重检测方法。一种方法是在新检测方法的ROC曲线和似然比分析中使用WB结果作为“相对金标准”。通过该分析确定了多重检测方法的临界值和解释范围。第二种统计方法使用贝叶斯模型来计算多重检测方法的诊断敏感性和特异性。贝叶斯分析考虑到不存在检测伯氏疏螺旋体抗体的真正金标准,并对两种比较检测方法的估计敏感性和特异性进行了比较。因此,贝叶斯分析还对WB的诊断敏感性和特异性进行了评估。总体而言,新检测方法的特点是背景值低,对伯氏疏螺旋体OspA、OspC和OspF抗原抗体检测的动态定量范围宽。基于OspA微球检测方法的诊断敏感性和特异性分别计算为49%和85%,仅通过标准ROC曲线分析得出,因为贝叶斯模型无法在此参数上运行。OspC和OspF检测方法的贝叶斯衍生诊断敏感性分别为80%和86%。相比之下,WB的贝叶斯衍生估计值显示,OspC的敏感性为72%,OspF的敏感性为80%。多重检测方法对OspC和OspF的贝叶斯诊断特异性分别为79%和69%。WB分析对OspC的特异性为92%,对OspF的特异性为77%。尽管在没有真正金标准的情况下对新检测方法进行分析仍然具有挑战性,但当新技术与传统使用的检测标准在分析敏感性上有显著差异,从而导致新检测方法的诊断敏感性和敏感性值计算出现问题时,这里使用的方法有助于解决这一问题。总之,用于检测马血清中针对伯氏疏螺旋体OspA、OspC和OspF抗原抗体的新型多重检测方法与WB分析相比,具有更高的分析和诊断敏感性。多重分析是一种有价值的定量工具,可同时检测指示莱姆病原体自然感染和/或疫苗接种的抗体。