化学发光免疫分析法与梅毒螺旋体明胶凝集试验检测梅毒螺旋体特异性抗体的比较

梅毒实验室诊断目前主要依靠血清学试验,国内大部分实验室开展的梅毒螺旋体特异性试验主要以梅毒螺旋体明胶凝集试验(TPPA)为主.而近20年快速发展的化学发光免疫分析法(CLIA)已广泛应用于各领域,但在梅毒的实验室诊断中的临床应用较少.为此,我们与本市3家实验室,对CLIA法检测梅毒螺旋体抗体结果进行了比对分析,现报告如下.     

大学生抑郁情绪及相关因素的初探

社会经济的快速发展、竞争压力的增大等社会因素导致大学生的心理卫生问题明显增多。有资料说明 ,以前影响大学生学习的主要原因是躯体疾病 ,现在 ,抑郁、精神分裂症等疾病已是升为主要原因[1] 。抑郁情绪的发生可能与大学生受各种生活事件的影响、以及对这些精神刺激的应付方式有密切的关系[2 ] 。本研究对部分大学生进行了调查 ,结果如下。1　对象与方法1.1　研究对象于 2 0 0 0年 10月 ,在某综合大学进行随机抽样 ,共抽取样本 15 0 0人。其中 ,男 95 1人 (6 3.4 % )、女5 4 9人 (36 .6 % ) ;平均年龄 17～ 2 3岁 (19.3± 2 .5 5 )。大学…     

梅毒非特异性类脂质反应素抗体试验操作的改进及应用评价

Objective To estimate the application value of a standard operating procedure (SOP) in the detection of syphilitic anticardiolipin reagin. Methods Clinical laboratories from 9 local hospitals in Shanghai participated the program. Quality control samples with unknown target value were qualitatively and quantitatively examined according to the uniform SOP in these laboratories with the same reagent and facility of horizontal reaction. External quality assessment (EQA) was carried out by using seven serum samples with no, or low (1∶ 128 dilution) to high (1∶1 dilution) concentrations of target before and after the implementation of SOP. The test results were statistically analyzed and the reasons for the detecting error were assessed. Results A total of 388 tests were performed in the 9 clinical laboratories. The total accuracy rate was 93.0%, including 40.2% in the detection of samples with 1 ∶ 8 dilution of target, 49.2% in the detection of samples with 1 ∶ 16 dilution of target, and 3.6% in the detection of samples with 1 ∶ 32 dilution of target. No forward bias was observed in these tests. There was a significant difference in the accuracy rate between the two times of EQA before and after the implementation of SOP (x2 = 4.17, P < 0.05). Conclusions The improved standard procedure for nontreponemal antigen test is beneficial to the decrease of testing error, and may provide a basis for the establishment of SOP and implementation of internal quality assessment.     

梅毒非特异性类脂质反应素抗体试验操作的改进及应用评价

Objective To estimate the application value of a standard operating procedure (SOP) in the detection of syphilitic anticardiolipin reagin. Methods Clinical laboratories from 9 local hospitals in Shanghai participated the program. Quality control samples with unknown target value were qualitatively and quantitatively examined according to the uniform SOP in these laboratories with the same reagent and facility of horizontal reaction. External quality assessment (EQA) was carried out by using seven serum samples with no, or low (1∶ 128 dilution) to high (1∶1 dilution) concentrations of target before and after the implementation of SOP. The test results were statistically analyzed and the reasons for the detecting error were assessed. Results A total of 388 tests were performed in the 9 clinical laboratories. The total accuracy rate was 93.0%, including 40.2% in the detection of samples with 1 ∶ 8 dilution of target, 49.2% in the detection of samples with 1 ∶ 16 dilution of target, and 3.6% in the detection of samples with 1 ∶ 32 dilution of target. No forward bias was observed in these tests. There was a significant difference in the accuracy rate between the two times of EQA before and after the implementation of SOP (x2 = 4.17, P < 0.05). Conclusions The improved standard procedure for nontreponemal antigen test is beneficial to the decrease of testing error, and may provide a basis for the establishment of SOP and implementation of internal quality assessment.     

梅毒非特异性类脂质反应素抗体试验操作的改进及应用评价

目的探讨标准化操作对梅毒非特异性类脂质反应素抗体试验的使用价值.方法上海市9个医院实验室按照统一的操作程序、使用相同试剂和水平反应装置,在检测系统受控情况下,对未知靶值(盲样)的梅毒血清质控品进行连续检测.在实施新操作方案前后,用一套靶值范围覆盖从阴性到1∶128的7份新鲜血清样品各进行一次室间质量评价.统计反馈结果,分析误差产生的原因.结果 9个实验室共计进行了388次肓样检测,结果分布在1∶8、1∶16和1∶32分别是40.2%、49.2%和3.6%,总合格率为93.0%,没有高于合格标准的正向偏倚结果.两次室间质量评价的合格率经统计学分析,差异有统计学意义(x2=4.17,P<0.05).结论改进的非梅毒螺旋体抗原试验程序有助于减少试验误差,为建立标准化操作和开展室内质控提供了基础.

Abstract：

Objective To estimate the application value of a standard operating procedure (SOP) in the detection of syphilitic anticardiolipin reagin. Methods Clinical laboratories from 9 local hospitals in Shanghai participated the program. Quality control samples with unknown target value were qualitatively and quantitatively examined according to the uniform SOP in these laboratories with the same reagent and facility of horizontal reaction. External quality assessment (EQA) was carried out by using seven serum samples with no, or low (1∶ 128 dilution) to high (1∶1 dilution) concentrations of target before and after the implementation of SOP. The test results were statistically analyzed and the reasons for the detecting error were assessed. Results A total of 388 tests were performed in the 9 clinical laboratories. The total accuracy rate was 93.0%, including 40.2% in the detection of samples with 1 ∶ 8 dilution of target, 49.2% in the detection of samples with 1 ∶ 16 dilution of target, and 3.6% in the detection of samples with 1 ∶ 32 dilution of target. No forward bias was observed in these tests. There was a significant difference in the accuracy rate between the two times of EQA before and after the implementation of SOP (x2 = 4.17, P < 0.05). Conclusions The improved standard procedure for nontreponemal antigen test is beneficial to the decrease of testing error, and may provide a basis for the establishment of SOP and implementation of internal quality assessment.     

梅毒非特异性类脂质反应素抗体试验操作的改进及应用评价

Objective To estimate the application value of a standard operating procedure (SOP) in the detection of syphilitic anticardiolipin reagin. Methods Clinical laboratories from 9 local hospitals in Shanghai participated the program. Quality control samples with unknown target value were qualitatively and quantitatively examined according to the uniform SOP in these laboratories with the same reagent and facility of horizontal reaction. External quality assessment (EQA) was carried out by using seven serum samples with no, or low (1∶ 128 dilution) to high (1∶1 dilution) concentrations of target before and after the implementation of SOP. The test results were statistically analyzed and the reasons for the detecting error were assessed. Results A total of 388 tests were performed in the 9 clinical laboratories. The total accuracy rate was 93.0%, including 40.2% in the detection of samples with 1 ∶ 8 dilution of target, 49.2% in the detection of samples with 1 ∶ 16 dilution of target, and 3.6% in the detection of samples with 1 ∶ 32 dilution of target. No forward bias was observed in these tests. There was a significant difference in the accuracy rate between the two times of EQA before and after the implementation of SOP (x2 = 4.17, P < 0.05). Conclusions The improved standard procedure for nontreponemal antigen test is beneficial to the decrease of testing error, and may provide a basis for the establishment of SOP and implementation of internal quality assessment.     

皮肤科病原菌及耐药菌感染控制与管理

<正>在全球细菌耐药性日益严重的今天,皮肤黏膜感染病原菌中出现了很多对临床常用抗菌药物耐药的致病菌,给皮肤黏膜感染治疗造成困难[1]。皮肤科患者的病原菌及耐药菌在医院环境中长时间生存,耐甲氧西林葡萄球菌在病区传播速度快、流行范围广及多药耐药的特征,可能导致病区内医院感染暴发流行[2-3]。不动杆菌可广泛定植于物体表面、患者的开放气道和患者及医护人员的皮肤。铜绿假单胞菌是人类的条件致病菌,在医院内广发定植于潮湿环境、物体表面、各     

上海市梅毒螺旋体血清学实验室室间质量评价

目的了解上海市各级医疗机构实验室开展梅毒螺旋体血清学检测质量及变化趋势。方法周期性地将一组样本发送到各实验室进行检测,比较每一实验室的结果与同组的其他实验室的结果/靶值,及时将比较的情况反馈给参与的实验室。结果2004年至2007年共进行了8次梅毒螺旋体血清学室间质量评价（EQA）。平均回报率超过97%。梅毒螺旋体筛查试验总合格率最高的为2004年（90.8%）,最低的为2005年（76.1%）;分析不同靶值样本结果,阴性和中、高滴度样本的合格率基本在80%,临界和弱阳性样本在32.7%和73.3%;1∶16或以上滴度的样本检测结果的变异系数（CV）值在10%或以下,而弱阳性样本的CV值超过90%;筛查试验的合格率按降序排列为二级医院（85.3%）、三级医院（83.5%）、民营医院（81.0%）和一级医院（76.6%）。4年中梅毒确诊试验总体合格率接近98%;各级医院分组的合格率差异不大。结论弱阳性样本筛查试验结果的CV值是影响整体EQA合格率的主要因素,不同级别的医疗机构,存在着检测质量的总体差异。需要及时调整专业管理模式,加强岗位培训的力度,探索提高检测质量的方法。     

梅毒血清学检测质量亟待提高

血清学实验是诊断梅毒的主要手段.一类以快速RPR或甲苯胺红不加热血清试验(TRUST)为代表的非梅毒螺旋体实验,通常称筛查试验;一类是以梅毒螺旋体明胶凝集实验(TPPA)为代表的梅毒螺旋体特异性试验,称确诊试验.由于实验原理易懂、操作简单、价格便宜,是医疗机构中普遍开展的检测项目.我们针对本市进行梅毒血清学检测质量的基线调查.现报道如下.