猫抓病血清学的陷阱与谬误：基于汉赛巴尔通体的间接荧光抗体试验和酶联免疫吸附测定的评估
Pitfalls and fallacies of cat scratch disease serology: evaluation of Bartonella henselae-based indirect fluorescence assay and enzyme-linked immunoassay.
作者信息
Bergmans A M, Peeters M F, Schellekens J F, Vos M C, Sabbe L J, Ossewaarde J M, Verbakel H, Hooft H J, Schouls L M
机构信息
Research Laboratory for Infectious Diseases, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
出版信息
J Clin Microbiol. 1997 Aug;35(8):1931-7. doi: 10.1128/jcm.35.8.1931-1937.1997.
The diagnostic value of the detection of immunoglobulin G (IgG) and IgM by Bartonella henselae-based indirect fluorescence assay (IFA) and enzyme-linked immunoassay (EIA) for the diagnosis of cat scratch disease (CSD) was evaluated. The IFA was performed either with B. henselae that was cocultivated for a few hours with Vero cells or with noncocultivated B. henselae as the antigen. Additionally, the performance of a Bartonella PCR hybridization assay based on the 16S rRNA gene was determined and compared with those of the serologic assays. The study group consisted of 45 patients suspected of suffering from CSD by fulfilling one or more of the classical criteria. The specificities of the immunoassays were set at > or = 95% by analysis of sera from 60 healthy blood donors. It is shown that the sensitivities of the IgG assays are very low (40.9% for the IFA with noncocultivated B. henselae as antigen) and that those of the IgM assays are higher (71.4% for the EIA) for patients who fulfilled two or more criteria for CSD. The IgM EIA showed the highest sensitivity: 71.4% in patients with two or more criteria for CSD and 80.6% for patients with a positive Bartonella PCR result. The results indicate that the specificities of both IFA and EIA IgG serologies and the sensitivity of the IFA IgM serology need to be improved. The PCR hybridization assay showed a sensitivity of 86.4% for patients who fulfilled two or more criteria for CSD and 100% for seven patients who fulfilled three or more criteria. The kinetics of IgG and IgM antibody production were studied in 18 patients with CSD on the basis of a positive B. henselae IFA IgM serology. The results indicate that there is no standard course of anti-B. henselae IgG and IgM production in patients with CSD, because some patients produced high levels of both IgG and IgM, others produced only high levels of IgM, and a few patients produced only low levels of antibodies.
评估了基于汉赛巴尔通体的间接荧光抗体试验（IFA）和酶联免疫吸附测定（EIA）检测免疫球蛋白G（IgG）和IgM对猫抓病（CSD）的诊断价值。IFA采用与Vero细胞共培养数小时的汉赛巴尔通体或未共培养的汉赛巴尔通体作为抗原进行检测。此外，还测定了基于16S rRNA基因的巴尔通体PCR杂交试验的性能，并与血清学检测方法进行了比较。研究组由45例符合一项或多项经典标准而疑似患有CSD的患者组成。通过分析60名健康献血者的血清，将免疫测定的特异性设定为≥95%。结果显示，对于符合两项或更多CSD标准的患者，IgG检测的敏感性非常低（以未共培养的汉赛巴尔通体为抗原的IFA检测为40.9%），而IgM检测的敏感性较高（EIA检测为71.4%）。IgM EIA显示出最高的敏感性：在符合两项或更多CSD标准的患者中为71.4%，在巴尔通体PCR结果呈阳性的患者中为80.6%。结果表明，IFA和EIA IgG血清学检测的特异性以及IFA IgM血清学检测的敏感性都需要提高。PCR杂交试验显示，对于符合两项或更多CSD标准的患者，敏感性为86.4%，对于符合三项或更多标准的7名患者，敏感性为100%。基于汉赛巴尔通体IFA IgM血清学检测阳性，对18例CSD患者的IgG和IgM抗体产生动力学进行了研究。结果表明，CSD患者抗汉赛巴尔通体IgG和IgM的产生没有标准过程，因为一些患者同时产生高水平的IgG和IgM，另一些患者仅产生高水平的IgM，还有少数患者仅产生低水平的抗体。
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