2013年HIV抗体免疫印迹试验确证不确定结果分析

摘要:目的　分析人类免疫缺陷病毒（HIV）抗体免疫印迹试验（WB）确证不确定结果的血清学特点及临床意义，探讨导致电化学发光法筛查假阳性且免疫印迹试验（WB）确证不确定的临床原因。方法　对四川大学华西医院2013年HIV抗体WB确证结果为不确定的107例患者的带型及其临床资料进行分析，其中有WB随访结果的患者47例以WB随访结果进行判断，无WB随访结果的患者60例，结合核酸（HIV-1 RNA）或HIV-1 P24抗原定量测定结果进行综合判断。结果　107例WB确证不确定患者共有16种带型，p24比例最高，占51.4%，其次是gp160+p24，占15.89%。env类、pol类、gag类分别占28.97%、6.54%、64.49%。在env类中，阳性患者的出现率最高，为67.74%，pol类和gag类分别为14.29%、2.90%。16例HIV抗体ELISA法和电化学发光法同时筛查阳性的患者，其最终结果为阳性的发生率为93.75%。83例最终确证结果为阴性的患者中，肿瘤患者的构成比最高，占27.71%。结论　在HIV抗体WB确证不确定的结果当中，env类提示HIV感染的作用最大；gag类大部分为非特异性反应。ELISA法和电化学发光法同时阳性时提示HIV阳性的可能性较大。疾病因素与HIV抗体WB不确定的发生相关。

Analysis of indeterminate HIV antibody western blot, 2013

Abstract: Objective To analyze the serological characteristics and clinical significance of indeterminate human immunodeficiency virus (HIV) antibody western blot, and explore the clinical causes of false positive in electrogenerated chemiluminescence (ECL) and indeterminate HIV antibody western blot. Methods We collected 107 cases with indeterminate HIV antibody western blot from West China Hospital in 2013, and analyzed their band types and clinical datas. The results of 47 patients receiving follow-up diagnostic testing were judged by the Welstern blot pattern and others supplemented by the viral load (HIV-1 RNA) or HIV-1 p24 antigen quantitative assay. Results There were 16 strip types in the 107 cases with the top two types of p24 (51.4%) and gp160p24 (15.89%). Of the 107 HIV antibody indeterminate cases, the proportions of env, pol and gag were 28.97%, 6.54%, 64.49%. The occurrence ratio of positive in env is 67.74%, higher than those in pol (14.29%) and gag (2.90%). Of the 16 patients with Enzyme-linked immuno sorbent assay (ELISA) and ECL positive simultaneously, the proportion of eventually positive is 93.75%. Of the 83 cases ultimately negative, and the constituent ratio of tumour is the highest (27.71%). Conclusion The Env indeterminacy had the greatest predictive value of HIV infection with the highest positive incidence. The indeterminacy of gag was most common in HIV antibody indeterminate samples, but most were unspecific reaction. There were great possibilities of HIV infection with ELISA and ECL positive simultaneously. The caused risk factors of diseases were correlated with the indeterminate status.