艾滋病病毒(HIV)抗体初筛检测实验结果分析与评价

目的：探讨进口胶体硒法代替ELISA法双孔复查的可行性。方法：用国产第三代试剂，采用ELISA法对艾滋病受检对象进行初筛，检测其血清中的抗-HIV；再将初筛阳性标本，分别用ELISA双孔实验和进口胶体硒实验复查，将两组结果进行比较分析。结果：11628份待测标本，用ELISA法对HIV抗体进行初筛，有554份标本为阳性。用两种不同方法复筛，其中S／CO比值≥6．0的72份标本，用两种方法复查均：勾阳性；而S／CO比值在1．0—6．0之间的482份标本，复查均为阴性。结论：在实际工作过程中，初筛S／CO比值≥6．0的标本，可以用进口胶体硒法代替双孔复查，即町省时、省力，并可减少实验室感染的危险性。     

艾滋病筛查阳性标本复检与确认试验结果的对比分析

目的通过HIV抗体酶联免疫吸附（ELISA）初筛试验与蛋白印迹（WB）确认试验结果的比对,探讨目前艾滋病检测存在的问题。方法对芜湖市2011年艾滋病筛查阳性标本复检与确证实验结果进行比对,并分析WB确认试验带型及感染者基本信息。结果 119份HIV抗体初筛阳性血清经WB确认80份阳性,23份阴性,16份不确定。其中,两种初筛试剂测试结果均阳性的93份标本经WB确认80份阳性,7份阴性,6份不确定;两种初筛试剂测试结果一阴一阳的26份血样经WB确认16份阴性,10份不确定。在80份HIV-1确认阳性标本中,P55条带出现次数最少,仅为50.00%。在16份不确定标本中,Gp160条带出现频率最高,占总不确定标本的62.50%。结论筛查弱阳性的标本尽量用筛查试剂排除,从而减少＂HIV抗体不确定＂结果。不确定结果与WB试验的假阳性有关,可结合流行病学资料对结果进行准确解释。     

山东省2003年艾滋病病毒抗体免疫印迹试验结果分析

[目的]确认山东省各地初筛HIV抗体阳性血清，并进行带型分析。[方法]2003年对山东省各地检测后上送的HIV抗体初筛阳性标本，用PA、ELISA试验复核，阳性者用WB试验进行确认，并进行基因分型。[结果]262份血清中，PA和ELISA复核152份为HIV抗体阳性(占58.01％)，其中125份确认为HIV-1抗体阳性；条带出现百分率gp160、p24为100％，gp120、gp41、p66、p51和p31在96％以上，p17、p55分别为86．4％和85．6％。[结论]艾滋病检测筛查实验室存在假阳性结果。     

山东省2003年艾滋病病毒抗体免疫印迹试验结果分析

[目的 ]确认山东省各地初筛HIV抗体阳性血清 ,并进行带型分析。 [方法 ] 2 0 0 3年对山东省各地检测后上送的HIV抗体初筛阳性标本 ,用PA、ELISA试验复核 ,阳性者用WB试验进行确认 ,并进行基因分型。 [结果 ] 2 62份血清中 ,PA和ELISA复核 15 2份为HIV抗体阳性 (占 5 8 0 1% ) ,其中 12 5份确认为HIV 1抗体阳性 ;条带出现百分率gp160、p2 4为 10 0 % ,gp12 0、gp41、p66、p5 1和 p3 1在 96%以上 ,p17、p5 5分别为 86 4%和 85 6%。[结论 ]艾滋病检测筛查实验室存在假阳性结果     

HIV抗体初筛阳性样本三种初筛试剂复检与确认试验结果的对比分析

目的评价三种不同原理初筛试剂检测艾滋病病毒(HIV)抗体的可靠性,探讨HIV抗体初筛试验阳性结果与确认试验结果之间的关系及一般规律.方法67份初筛为HIV抗体阳性的样本,用三种不同原理的初筛试剂复检,并进一步用蛋白印迹试验(WB)确认.结果67份样本中,有44份三种初筛检测均为阳性,WB确认为HIV抗体阳性;有1份三种初筛检测为阳性,(WB)确认试验为不确定;有2份三种初筛检测为阳性,WB确认试验为阴性;有2份二种初筛试验为阳性,WB试验为阴性;有3份一种初筛试验为阳性,WB试验为不确定.其余15份均为一种初筛试验阳性,WB试验阴性.结论三种不同原理的初筛试剂联合检测HIV抗体与WB确认检测具有一定的相关性,在对个体进行诊断时,为慎重起见,必须经WB法确认.     

HIV抗体筛查阳性标本与免疫印迹试验结果的对比分析

目的探讨HIV抗体筛查(ELISA)与免疫印迹(WB)试验之关系,为提高艾滋病检测技术提供依据。方法操作及结果判断按照《全国艾滋病检测技术规范》实施,对于HIV抗体初筛检测呈阳性反应的样本采用免疫印迹试验进行确证。结果 468例HIV抗体复核样本中,两种ELISA都呈阳性反应的464例,与WB的阳性符合率为99.13%;复核实验一阴一阳4例,与WB的阳性符合率0%;S/CO值落在1~6之间,阳性符合率为92.50%;S/CO值在6~10之间,确证试验阳性符合率为99.17%;S/CO值≥10,确证试验符合率为99.63%;所有的确证样本中,HIV-1抗体特异带的gp160、gp120、gp41、p24的出现都在98.00%以上,其中有4例同时出现HIV-2型抗体条带gp36。结论 ELISA诊断试剂存在有一定的假阳性,随着S/CO值的增高,与确证试验的阳性符合率也将升高,但是,高S/CO值的样本并不代表感染HIV,低S/CO值也不能代表HIV阴性,所以,HIV抗体阳性的报告应以确证试验的结果为准。     

血清HIV抗体筛查阳性与免疫蛋白印迹试验结果对比分析

目的对比分析血清HIV抗体筛查试验阳性与免疫印迹试验(WB)结果之间的关系,为艾滋病诊断和提高检测技术水平提供依据。方法按照《全国艾滋病检测技术规范》(2009年版)[1]要求,对HIV抗体初筛阳性血清进行复检,复检阳性的血清采用免疫印迹试验进行确证。结果对2010-2011年共270份初筛阳性血清进行复检,复检后249份HIV抗体阳性血清经WB法确证,217份为HIV-1型抗体阳性(87.15%),15份为不确定(6.02%),17份阴性(6.83%)。复检结果 1≤S/CO<6、6≤S/CO<10和S/CO≥10与WB确证试验阳性符合率分别为51.28%、86.25%和98.46%。确证为HIV-1型抗体阳性的血清,gp 160、gp 120、gp 41、p 66、p 51、p 24出现频率都在93%以上。结论筛查试验存在假阳性结果,HIV抗体结果的报告必需以确证结果为准。随着S/CO值的增高,与确证试验的阳性符合率也升高,但WB确证试验存在不确定结果,也有一定的缺陷。     

新兵260名血清中艾滋病抗体检测假阳性结果分析

目的了解新兵艾滋病抗体初筛检测中假阳性结果真实情况,探讨初筛实验与确认实验之间关系,为提高艾滋病检测技术提供依据。方法采用酶联免疫吸附试验（ELISA）技术,对2000--2007年期间应征入伍的新兵进行艾滋病抗体初筛检测,阴性者判定阴性,阳性者再用另外一种试剂复核,复核阳性标本再送全军艾滋病检测中心采用免疫印迹试剂进行确认。结果6年间共检测新兵血清标本49017份,筛查出260份阳性血清标本,发现初筛所能够捡出的全部抗-HIV阳性标本,经复核和确认实验后,100％为HIV抗体阴性,（S／CO）值在1．000～5．000范围的249份,占95．8％;超过5以上的11份,占4．2％。结论新兵人群艾滋病病毒抗体检测存在一些假阳性结果,复核实验是有效排除假阳性、提高确认效率、节省经费开支的有效措施。     

孕产妇HIV抗体筛查阳性与免疫印迹试验对比

目的探讨孕产妇人类免疫缺陷病毒（HIV）抗体筛查试验阳性与免疫印迹试验（WB）结果的关系。方法对33份孕产妇HIV抗体待复查样本,进行酶联免疫吸附试验（ELISA）及免疫印迹试验（WB）,对WB试验结果不确定者进行3个月、6个月随访检测,6个月随访样本补充HIV-1病毒载量检测,分析ELISA检测与WB试验检测结果。结果 33份样本ELISA复检均呈阳性,免疫印迹试验（WB）中20份确认为HIV-1抗体阳性,ELISA检测与WB试验阳性符合率为60.61%（20/33）;S/CO值〉8的20份样本,WB试验结果均为HIV-1抗体阳性,1〈S/CO值〈8的13份样本,WB试验5份为HIV抗体阴性,8份为HIV抗体不确定;6个月随访样本HIV-1病毒载量检测,结果均小于最低检测限（50 IU/ml）。结论孕产妇HIV抗体筛查（ELISA）假阳性较高,假阳性样本存在于WB试验抗体阴性和不确定结果之中;随着ELISA试验S/CO值增高,ELISA检测与WB试验的阳性符合率随之增高。     

HIV抗体筛查与免疫印迹确证结果一致性分析

目的通过对HIV抗体筛查(ELISA)阳性标本进行免疫印迹确证试验(WB),分析两者之间的关系。方法对初筛阳性血清用胶体硒和ELISA试验复检,任一复检试验阳性的血清再用WB试验确认。结果 236份初筛阳性血清经复检后,有228份为阳性。复检阳性样本经WB确认后,有163份为HIV-l抗体阳性,有24份不确定,41份为阴性。以WB结果为标准,ELISA、胶体硒法的阳性符合率分别为71.71%和86.70%。ELISA的敏感性为100%,特异性为43.36%;胶体硒法的敏感性为94.76%,特异性为66.22%。结论胶体硒和ELISA复检可排除大部分初筛假阳性,但两种复检试验均存在一定的假阳性;三种试验的不符情况仅出现在HIV抗体阴性和不确定组;确定HIV感染依赖于WB确认试验。     

新生儿听力筛查最佳测试时间及测试结果分析

目的：分析新生儿听力筛查最佳测试时间及测试结果，以此减少筛查中发生假阳性率。方法选择2014年10月至2015年1月本院产科出生的400例Apgar评分5分以上的新生儿作为研究对象，把400例新生儿随机分成对照组与观察组，每组各200例。初次筛选应用耳声发射仪，复筛和诊断性筛查应用脑干诱发电位仪。观察组筛查时间选择新生儿出生48 h内，对照组筛查时间选择出生72～96 h ，比较两组新生儿筛查结果。结果经过听力筛查，观察组与对照组新生儿通过率和假阳性率对比，无显著差异（P＞0．05）；观察组的筛查更顺利，可以在新生儿出院以前顺利完成筛查工作。结论对Apgar评分在5分以上新生儿进行听力筛查，应该在出生后48 h内完成。     

化学荧光法筛查苯丙酮尿症的影响因素分析

【目的】探讨化学荧光法在筛查苯丙酮尿症(phenylketonuria,PKU)的实验操作中存在的诸方面影响因素,以便提高筛查质量。【方法】使用化学荧光定量法,通过试剂加入量的变化,观察对实验结果的影响。【结果】标本洗脱液体积每增减变化10μL,实验检测苯丙氨酸(Phe)结果减增16%左右,二者呈现反比关系变化。Phe提取液体积每增减变化10μL,实验结果增减14%左右,二者呈正比关系变化。显色剂体积变化将影响标准曲线斜率变化。体积增或减均造成斜率下降,使实验灵敏度下降。稳定剂体积变化将影响标准曲线斜率变化,二者呈正比关系变化。使用常规批量操作的手法测验8道加样器误差:8道CV在7.1%~3.0%之间。【结论】鉴于新生儿筛查的不可漏诊性及工作量大的特点,为保障筛查质量,在保证试剂及仪器质量的前提下,应该加强对使用的加样工具进行标定并应参照本研究结果,规范实验者的操作手法。     

中孕期唐氏综合征三联筛查与二联筛查的筛查效率

目的:比较中孕期唐氏综合征产前筛查中三联筛查与二联筛查的筛查效率,以及评估游离雌三醇(uE3)在产前筛查中的价值。方法:采用时间分辨荧光免疫检测技术,对同意接受产前筛查的孕14~20+6周单胎妊娠以及已经确诊唐氏综合征妊娠孕妇的冻存血清标本进行检测,测定甲胎蛋白(AFP)、人绒毛膜促性腺激素游离β亚基(freeβ-HCG)、uE3浓度,应用L ifeCyc le软件分别计算三联筛查(AFP+freeβ-HCG+uE3)和二联筛查(AFP+freeβ-HCG)的风险值,比较三联筛查与二联筛查对唐氏综合征的检出率和假阳性率。结果:在1 078例中孕期产前筛查以及10例冻存血清标本的唐氏综合征孕妇中,当风险截断值为1/270时,三联筛查与二联筛查对唐氏综合征的检出率均为66.7%,假阳性率分别为4.6%与7.2%;当截断值为1/380时,三联筛查的检出率高于二联筛查(91.7%vs 75.0%),假阳性率分别为7.5%与10.1%。结论:三联筛查是比二联筛查更有效的唐氏综合征筛查方法,有必要制定适合本地区人群的风险切割值,以提高产前筛查的筛查效率。     

An investigation into aspects of the Mayo early language screening test

The concurrent validity and inter-tester agreement on the Mayo early language screening test (MELST), and the concurrent validity of parental anxiety about speech and language development as a screening measure were investigated. A sample (aged 18 months to 5 years) comprising 120 children referred to the Mayo speech and language therapy department during 1995 and 80 controls, was assessed on the MELST by their local public health nurse. Within a calendar month each child was reassessed on the MELST by the therapist, who also administered the Reynell developmental language scales (RDLS) and the Edinburgh articulation test (EAT) as criterion measures. Overall, the MELST achieved moderately high sensitivity and specificity measures. Phonological problems were identified with more accuracy than language problems and the test was equally sensitive to impairments in comprehension and expression. The test tended to over-refer and was least accurate in screening the language skills of children at the highest age level (4-5 years). A significant association was found between parental concern and pass/failure on each of the MELST, RDLS and EAT. As a screening measure, parental anxiety achieved high sensitivity, moderate specificity and a moderate positive predictive value. However, it also tended to over-refer, and was also least accurate in identifying speech and/or language disorders at the highest age level. Moderately high inter-tester agreement measures were found, with greater agreement between scoring for controls than referrals. The phonology sections were scored significantly higher by the public health nurses than by the therapist. The results of this study imply that the MELST is sufficiently accurate and reliable to recommend its continued use in child surveillance programmes.     

Prevalence estimation when disease status is verified only among test positives: Applications in HIV screening programs

The first goal of the United Nations' 90–90–90 HIV/AIDS elimination strategy is to ensure that, by 2020, 90% of HIV‐positive people know their HIV status. Estimating the prevalence of HIV among people eligible for screening allows assessment of the number of additional cases that might be diagnosed through continued screening efforts in this group. Here, we present methods for estimating prevalence when HIV status is verified by a gold standard only among those who test positive on an initial, imperfect screening test with known sensitivity and specificity. We develop maximum likelihood estimators and asymptotic confidence intervals for use in 2 scenarios: when the total number of test negatives is known (Scenario 1) and unknown (Scenario 2). We derive Bayesian prevalence estimators to account for non‐negligible uncertainty in previous estimates of the sensitivity and specificity. The Scenario 1 estimator consistently outperformed the Scenario 2 estimator in simulations, demonstrating the use of recording the number of test negatives in public health screening programs. For less accurate tests (sensitivity and specificity < 90%), the performance of the 2 estimators was comparable, suggesting that, under these circumstances, prevalence can still be estimated with adequate precision when the number of test negatives is unknown. However, use of the Bayesian approach to account for uncertainty in the sensitivity and specificity is especially recommended for the Scenario 2 estimator, which was particularly sensitive to misspecification of these values. R code for implementing these methods is available at hsph.harvard.edu/donna‐spiegelman/software.     

陆军战场搜救装备体系作战试验研究

目的:对战场搜救装备体系作战试验指标和试验设计进行研究,验证战场搜救装备体系建设效果。方法:基于战场搜救的特殊要求提出战场搜救装备体系作战试验需求。采用逐级分解的方法构建搜救体系效能指标、体系融合度指标和体系贡献率指标,采用重要度(Concernment )、有效性(Validity)、稳定性( Stability),即CVS方法进行指标体系筛选,以定位感知能力指标体系为例给出指标值度量方法。结合卫勤演训任务,在作战试验想定和作战试验科目设置基础上开展体系作战试验。结果:战场搜救装备体系作战试验方法能够满足作战试验要求。结论:战场搜救装备体系作战试验方法具有较好的可行性,可为评估搜救装备体系效能、体系融合度和体系贡献率提供支撑。     

医用检验仪器故障分析与研究

医用检验仪器的正常运行与操作者、仪器本身和环境有着重要的关系，总结几年来医书检验仪器的管理、维修，对其故障原因进行了分析与研究。     

Effectiveness of an intervention to increase Pap test screening among Chinese women in Taiwan

This study assessed the effectiveness of a theory-based direct mail campaign in encouraging non-compliant women, aged 30 and older or younger if married, to obtain a Pap test. Participants were female family members of inpatients admitted to one of the major teaching hospitals in Taiwan during August–September 1999. A total of 424 women were recruited in the randomized intervention trial. Three months following implementation of the intervention, women in the intervention group reported a higher rate of Pap test screening than women in the comparison group (50% versus 32%) (p = 0.002). Women in the intervention group also showed higher perceived pros of a Pap test at follow-up (p = 0.031). Although women in both groups showed an increased knowledge and intention to obtain a Pap, only the intervention group had significantly higher follow-up scores on perceived pros and susceptibility. The results shows that the intervention was effective in increasing Pap test screening among Chinese women within three months. The results also support the use of Intervention Mapping, a systematic program development framework for planning effective interventions.     

Faecal occult blood test: current practice in a rural Queensland community

ABSTRACT: The findings of a recent telephone survey of 604 residents (50–74 years of age) in a rural community in Queensland are presented. The survey focused on the participants' knowledge concerning the faecal occult blood test (FOBT) and their previous testing history. Responses were analysed in terms of gender, age and education differences. More than half of all participants were aware of the FOBT, and 109 (18%) had undergone FOBT in the past. Fewer understood the importance of 'health checks without symptoms' than the 'advantage of early treatment'. The most common reasons to use FOBT were: 'prevention' and 'I want to know if I have cancer'. A person's gender, age and education were shown to be associated with their knowledge and beliefs. These results suggest an increase in the use of the FOBT with time (in relation to previous surveys), but a poor understanding of its place in promoting health.