López Myriam Consuelo, Moncada Ligia Inés, Ariza-Araújo Yoseth, Fernández-Niño Julián Alfredo, Reyes Patricia, Nicholls Rubén Santiago
Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
Biomedica. 2013 Jan-Mar;33(1):128-36. doi: 10.1590/S0120-41572013000100016.
Soil-transmitted helminth infections are considered a public health problem in developing countries. The diagnostic tests, both for individual parient diagnosis as for population studies should be evaluated in terms of validity and reliability.
To compare the direct examination, the modified Ritchie-Frick method, a Kato-Katz designed by a Brazilian group and one designed by the WHO, for the diagnosis of soil-transmitted helminthes.
A diagnostic test reliability study was performed. The same stool sample was analyzed by the same observer using four diagnostic tests. 204 samples were obtained, 194 of those fulfilled the inclusion criteria and were analyzed. The observers did not know the participants' identity neither the other tests results. For the analysis the Kato-Katz (WHO) was considered as the gold standard. For the reliability assessment percent agreement, positive percent agreement, Kappa statistic, and intraclass correlation were performed.
The Brazilian Kato-Katz showed a good performance with high sensitivity and specificity for T. trichiura and Hookworm with values of 0.97 and 0.96 respectively, and a high specificity with mild sensitivity for A. lumbricoides (0.95 and 0.79) meanwhile the direct examination and the Ritche-Frick method showed a performance between mild and poor. The differences were higher for hookworm and Trichiuris trichiura than for Ascaris lumbricoides.
The Brazilian Kato Katz test could be implemented, but further studies are needed to correlate its operative capacity with its feasibility, availability and cost.
在发展中国家，土壤传播的蠕虫感染被视为一个公共卫生问题。对于个体患者诊断以及人群研究的诊断测试，都应从有效性和可靠性方面进行评估。
比较直接检查法、改良的里奇 - 弗里克法、巴西团队设计的加藤 - 厚涂片法以及世界卫生组织设计的加藤 - 厚涂片法，用于诊断土壤传播的蠕虫。
进行了一项诊断测试可靠性研究。同一位观察者使用四种诊断测试对同一粪便样本进行分析。共获取204份样本，其中194份符合纳入标准并进行了分析。观察者既不知道参与者的身份，也不知道其他测试结果。分析时，将加藤 - 厚涂片法（世界卫生组织版）视为金标准。进行可靠性评估时，计算了百分比一致性、阳性百分比一致性、卡帕统计量和组内相关性。
巴西加藤 - 厚涂片法表现良好，对鞭虫和钩虫具有高敏感性和特异性，值分别为0.97和0.96，对蛔虫具有高特异性和轻度敏感性（0.95和0.79），而直接检查法和里奇 - 弗里克法表现介于轻度和较差之间。钩虫和鞭虫的差异比蛔虫更高。
巴西加藤 - 厚涂片法可以实施，但需要进一步研究将其操作能力与其可行性、可用性和成本相关联。
