Jiang Li, Wang Zhen-yu, Zhang Yao-guang, Zhu Min, Zhang Xiao-ping, Ma Xiao-jiang, He Yan-yan, Zhu Qian, Jiang Shou-fu, Cai Li
Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi. 2017 Feb;35(1):53-8.
To test the usage of microscopic examination, antigen detection(rapid dignostic test, RDT) and nucleic acid test(PCR) for detection of malaria cases.
The blood test results for malaria and suspected malaria cases during 2012-2015 were retrospectively reviewed. Taking the confirmed cases as a gold standard, the three methods were compared in aspects of diagnosis indices, specificity of identification species, and cost effectiveness.
A total of 212 samples were included, each analyzed with the three methods. Based on the results of the three tests, 167(78.8%) were determined to be positive for malaria, and 45 negative (21.2%). Of the positive samples, 120(71.9%) were infected with Plasmodium falciparum,22(13.2%) with P. vivax,17(10.2%) with P. ovale, 6 (3.6%) with P. malariae, and 2(1.2%) with mixed infections. The method of PCR had the highest diagnostic efficiency (96.2%,204/212), followed by RDT (93.2%,192/206; P > 0.05 vs. PCR) and the microscopic method (88.2%,187/212; P < 0.05 vs. RDT and PCR). Similarly, the PCR method had the highest overall coincidence rate to the confirmed cases (95.3%,202/212), followed by RDT (93.2%,192/206) and microscopy (88.2%,187/212; P < 0.05 vs. PCR). As to the identification specificity among species, the PCR method(95.6%, 43/45) was superior to microscopy (91.1%, 41/45; P > 0.05 vs. PCR) and RDT (68.9%, 31/45; P < 0.05 vs. PCR). As to the identification of a particular species (P. falciparum), RDT performed best (100%,116/116), followed by PCR (93.3%,112/120) and microscopy (84.2%,101/120). Based on the comprehensive evaluation on 14 indicators including if it is a diagnostic criterion, equipment and technical requirement, diagnostic performance, time cost, and the need of technical training and promotion, we found that the RDT method had the highest score(37 of 42), while microscopy and PCR were scored 26 and 27, respectively.
Under the falciparum malaria-dominated epidemiological situation, PCR and RDT show a higher detection efficiency, PCR and microscopy perform better in species identification, and RDT has the highest cost-effectiveness.
检测显微镜检查、抗原检测（快速诊断试验，RDT）和核酸检测（PCR）在疟疾病例检测中的应用情况。
回顾性分析2012 - 2015年疟疾及疑似疟疾病例的血液检测结果。以确诊病例为金标准，比较三种方法在诊断指标、物种鉴定特异性和成本效益方面的差异。
共纳入212份样本，每种样本均采用三种方法进行分析。根据三项检测结果，167份（78.8%）被判定为疟疾阳性，45份为阴性（21.2%）。在阳性样本中，120份（71.9%）感染恶性疟原虫，22份（13.2%）感染间日疟原虫，17份（10.2%）感染卵形疟原虫，6份（3.6%）感染三日疟原虫，2份（1.2%）为混合感染。PCR方法的诊断效率最高（96.2%，204/212），其次是RDT（93.2%，192/206；与PCR相比，P>0.05）和显微镜检查法（88.2%，187/212；与RDT和PCR相比，P<0.05）。同样，PCR方法与确诊病例的总体符合率最高（95.3%，202/212），其次是RDT（93.2%，192/206）和显微镜检查（88.2%，187/212；与PCR相比，P<0.05）。在物种鉴定特异性方面，PCR方法（95.6%，43/45）优于显微镜检查（91.1%，41/45；与PCR相比，P>0.05）和RDT（68.9%，31/45；与PCR相比，P<0.。在鉴定特定物种（恶性疟原虫）方面，RDT表现最佳（100%，116/116），其次是PCR（93.3%，112/120）和显微镜检查（84.2%，101/120）。基于对包括是否为诊断标准、设备和技术要求、诊断性能、时间成本以及技术培训和推广需求等14项指标的综合评估，我们发现RDT方法得分最高（42分中的37分），而显微镜检查和PCR分别得26分和27分。
在以恶性疟为主的流行态势下，PCR和RDT检测效率较高，PCR和显微镜检查在物种鉴定方面表现较好，RDT具有最高的成本效益。
