舟山海岛HIV抗体不确定者相关影响因素监测分析
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摘要
目的分析舟山海岛HIV抗体免疫印迹试验(WB)确证不确定结果的血清学特点和临床意义,探讨导致WB确证不确定的原因。方法 40例HIV抗体不确定的样本进行随访复检,对WB条带不进展的病例,结合HIV-1核酸检测;最后判定为HIV未感染的病例,查找临床资料,并检测乙型肝炎病毒(HBV)抗原、丙型肝炎病毒(HCV)抗体、梅毒螺旋体(TP)抗体、人类嗜T细胞病毒(HTLV)Ⅰ型和Ⅱ型的感染状况及抗核抗体(ANA)、甲胎蛋白(AFP)在血液中的含量。结果 40例HIV抗体不确定病例中,有9例条带进展为HIV-1型抗体阳性;1例未随访即死亡;2例条带不进展,但HIV-1核酸阳性;另2例条带为gp160、gp120、p24,经过多次随访后,最后报告为"无HIV感染";28例无HIV感染的患者,有5例HBV Ag阳性、2例现症梅毒、1例梅毒既往感染、3例ANA阳性、5例AFP定量高于正常值。结论对HIV抗体不确定的结果,需要结合HIV核酸检测;WB条带为gp160、gp120、p24的,需谨慎报告HIV-1型抗体阳性;临床上其他疾病因素与WB不确定的发生相关,但是更多的是不明原因的免疫交叉反应。
Objective To analyze the serological characteristics and clinical significance of Western blot(WB) in detecting indeterminate HIV antibody in Zhoushan Islands,so as to explore the reasons for indeterminate WB. Methods Samples from forty patients with indeterminate HIV antibodies were followed up for reexamination,and the cases without HIV-1 belts progress were detected combined with HIV-1 nucleic acid detection; as for the cases without HIV infection,the clinical data were collected,and hepatitis B virus(HBV) antigen,hepatitis C virus(HCV) antibody,Treponema pallidum(TP) antibody and human T lymphotropic virus(HTLV) infection in type I and type II and anti nuclear antibody(ANA),alpha fetoprotein(AFP) content in the blood were detected for comprehensive analysis. Results Of forty patients with indeterminate HIV antibodies,nine patients progressed to type HIV-1 antibody positive; one patient died before to be followed up; two patients had no progression of HIV antibody,but their HIV-1 nucleic acid were positive; two patients had gp160,gp120 and p24 of the WB belts,and after many follow-ups,the final report was non HIV infection; in twenty-eight patients without HIV infection,there were five cases of HBV Ag,two cases of syphilis,one case of syphilis infection,three cases of anti nuclear antibody(ANA),and alpha fetoprotein content in five cases were much higher than normal value. Conclusion Uncertain results for HIV antibodies require HIV nucleic acid detection; as for WB bands of gp160,gp120,p24,and positiveness of HIV-1 antibody should be reported cautiously; other clinical disease factors,which are mainly unexplained immune cross-reactivity,and are associated with WB uncertainty.
Objective To analyze the serological characteristics and clinical significance of Western blot(WB) in detecting indeterminate HIV antibody in Zhoushan Islands,so as to explore the reasons for indeterminate WB. Methods Samples from forty patients with indeterminate HIV antibodies were followed up for reexamination,and the cases without HIV-1 belts progress were detected combined with HIV-1 nucleic acid detection; as for the cases without HIV infection,the clinical data were collected,and hepatitis B virus(HBV) antigen,hepatitis C virus(HCV) antibody,Treponema pallidum(TP) antibody and human T lymphotropic virus(HTLV) infection in type I and type II and anti nuclear antibody(ANA),alpha fetoprotein(AFP) content in the blood were detected for comprehensive analysis. Results Of forty patients with indeterminate HIV antibodies,nine patients progressed to type HIV-1 antibody positive; one patient died before to be followed up; two patients had no progression of HIV antibody,but their HIV-1 nucleic acid were positive; two patients had gp160,gp120 and p24 of the WB belts,and after many follow-ups,the final report was non HIV infection; in twenty-eight patients without HIV infection,there were five cases of HBV Ag,two cases of syphilis,one case of syphilis infection,three cases of anti nuclear antibody(ANA),and alpha fetoprotein content in five cases were much higher than normal value. Conclusion Uncertain results for HIV antibodies require HIV nucleic acid detection; as for WB bands of gp160,gp120,p24,and positiveness of HIV-1 antibody should be reported cautiously; other clinical disease factors,which are mainly unexplained immune cross-reactivity,and are associated with WB uncertainty.
引文
[1]中国疾病预防控制中心.全国艾滋病检测技术规范[Z].2009-09.
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[3]温鸿,金晓敏,周铁丽.622例HIV抗体筛查阳性病例采用免疫印迹试验确认结果分析[J].中国地方病防治杂志,2014,29(4):300-301.
[4]朱群,詹洁群,周子荣.HIV抗体筛查与免疫印迹确证结果一致性分析[J].健康教育与健康促进,2015,10(2):142-144.
[5]朱厚宏,刘杨,张祈,等.HIV抗体确证实验结果不确定样本的检测分析[J].现代预防医学,2011,38(3):533-534,539.
[6]范炜,燕清丽.2014-2015年江苏淮安市HIV抗体筛查阳性样本确证结果分析[J].公共卫生与预防医学,2016,27(6):114-115.
[7]夏燕,郭志宏,张佳峰,等.浙江省55例HIV抗体检测不确定结果的随访复检与处理对策[J].中国艾滋病性病,2015,21(4):283-286.
[8]Huang LJ,Liu CY,Chu SC,et al.Predictive value of two commercial human immunodeficiency virus serological tests in cases with indeterminate Western blot results[I].J Microbiol Immunol Infect,2006,39(3):219-224.
[9]吴可可,李伟,虞成超,等.HIV-1抗体不确定标本的血清学特征与病毒载量[J].中国卫生检验杂志,2015,25(2):202-203.
[10]潘海西,秦剑秋.78份HIV抗体不确定标本的结果分析[J].医学动物防治,2016,32(4):460-461.
[11]缪礼锋,沈月兰,吴建军,等.HIV抗体蛋白印迹试验不确定结果的血清学特征及病毒载量辅助诊断的意义[J].中国艾滋病性病,2016,22(3):150-154.
[12]杨晓莉,李敬云,郝钦芳,等.HIV抗体不确定及HIV抗体检测非特异反应的人群回顾性研究[J].中华医院感染学杂志,2010,20(13):1844-1846.
[13]张佳峰,郭志宏,姚亚萍,等.1155例的HIV-1抗体阳性者免疫印迹带型分析及规律总结[J].中国卫生检验杂志,2010,20(9):2247-2249.
[14]杨洋,白梅,张振,等.锦州市2014年-2016年HIV抗体筛查阳性样本确证实验结果分析[J].中国卫生检验杂志,2017,27(15):2162-2163,2169.
[15]田永芳,李奇凤.乌鲁木齐某医院HIV抗体筛查阳性标本免疫蛋白印迹试验结果分析[J].中国临床研究,2017,30(8):1090-1092.
[16]李沛然,陈霖,郭素丽,等.331例HIV抗体确证阳性标本的确证结果分析[J].中国热带医学,2016,16(11):1126-1128.
[17]练维,张宏萍,陆娟,等.南通市2011-2015年HIV抗体不确定标本的检测结果及随访分析[J].国际检验医学杂志,2017,38(19):2751-2753.
[2]中国疾病预防控制中心.全国艾滋病检测技术规范[Z].2015-12.
[3]温鸿,金晓敏,周铁丽.622例HIV抗体筛查阳性病例采用免疫印迹试验确认结果分析[J].中国地方病防治杂志,2014,29(4):300-301.
[4]朱群,詹洁群,周子荣.HIV抗体筛查与免疫印迹确证结果一致性分析[J].健康教育与健康促进,2015,10(2):142-144.
[5]朱厚宏,刘杨,张祈,等.HIV抗体确证实验结果不确定样本的检测分析[J].现代预防医学,2011,38(3):533-534,539.
[6]范炜,燕清丽.2014-2015年江苏淮安市HIV抗体筛查阳性样本确证结果分析[J].公共卫生与预防医学,2016,27(6):114-115.
[7]夏燕,郭志宏,张佳峰,等.浙江省55例HIV抗体检测不确定结果的随访复检与处理对策[J].中国艾滋病性病,2015,21(4):283-286.
[8]Huang LJ,Liu CY,Chu SC,et al.Predictive value of two commercial human immunodeficiency virus serological tests in cases with indeterminate Western blot results[I].J Microbiol Immunol Infect,2006,39(3):219-224.
[9]吴可可,李伟,虞成超,等.HIV-1抗体不确定标本的血清学特征与病毒载量[J].中国卫生检验杂志,2015,25(2):202-203.
[10]潘海西,秦剑秋.78份HIV抗体不确定标本的结果分析[J].医学动物防治,2016,32(4):460-461.
[11]缪礼锋,沈月兰,吴建军,等.HIV抗体蛋白印迹试验不确定结果的血清学特征及病毒载量辅助诊断的意义[J].中国艾滋病性病,2016,22(3):150-154.
[12]杨晓莉,李敬云,郝钦芳,等.HIV抗体不确定及HIV抗体检测非特异反应的人群回顾性研究[J].中华医院感染学杂志,2010,20(13):1844-1846.
[13]张佳峰,郭志宏,姚亚萍,等.1155例的HIV-1抗体阳性者免疫印迹带型分析及规律总结[J].中国卫生检验杂志,2010,20(9):2247-2249.
[14]杨洋,白梅,张振,等.锦州市2014年-2016年HIV抗体筛查阳性样本确证实验结果分析[J].中国卫生检验杂志,2017,27(15):2162-2163,2169.
[15]田永芳,李奇凤.乌鲁木齐某医院HIV抗体筛查阳性标本免疫蛋白印迹试验结果分析[J].中国临床研究,2017,30(8):1090-1092.
[16]李沛然,陈霖,郭素丽,等.331例HIV抗体确证阳性标本的确证结果分析[J].中国热带医学,2016,16(11):1126-1128.
[17]练维,张宏萍,陆娟,等.南通市2011-2015年HIV抗体不确定标本的检测结果及随访分析[J].国际检验医学杂志,2017,38(19):2751-2753.
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