rK39免疫层析试条在新疆黑热病诊断和流行病学调查中的应用

目的观察rK39免疫层析试条对新疆不同类型黑热病的诊断及流行病学调查中的应用价值。方法用rK39试条检查不同地区确诊的黑热病患者;用rK39-ELISA和rK39免疫层析试条检查不同流行地区居民血清标本与利什曼素皮内反应结果进行比较分析。结果对来自新疆不同地区的黑热病患者共1204例,用rK39试条检测抗体阳性者1169例,阳性率97.09%。其中人源型黑热病患者1052例中1031例阳性,阳性率98.0%;荒漠型黑热病患者158例中阳性143例,阳性率90.5%。二者之间差异显著(P<0.001),荒漠型患者阳性率较低。人源型黑热病流行区居民中rK39抗体阳性率在既往有黑热病史者中为42.7%～59.3%,在无既往史的居民中仅为2.2%～5.8%。在随访的rK39阳性,皮内反应阴性的18人中有4人在4和6个月后出现症状,确诊为黑热病。在黑热病治愈后2年内94.6%的患者rK39抗体仍为阳性。9年后仍有82.5%保持阳性。结论rK39层析试条对新疆黑热病患者有很高的诊断价值。其保存、携带方便,操作简单适于在基层现场使用。由于其可在潜伏期中发现黑热病患者。故可用于在流行地区皮内反应阴性的居民中进行免疫学检测,早期发现病人。由于黑热病患者治愈后血清中rK39抗体长期存在,故不适用于预后判定和疗效评价。

Application of rK39 dipstick on diagnosis and epidemiological survey of kala-azar in Xinjiang,China

Objective To observe the value of rK39 dipstick on the diagnosis and epidemiological survey in patients with kala-azar from different areas of Xinjiang.Methods The patients with kala-azar were examined with rK39 dipstick.A serological survey in residents of different endemic areas was carried out with rK39-ELISA and the result were compared with that of Montenegro test.Results Of 1204 cases with kala-azar from different areas,1169 cases were positive with the antibody tested with rK39 dipstick.The positive rate was 97.09%.Of 1052 cases with kala-azar of anthropologic type,1031 cases were positive(98.0%),while 158 cases with kala-azar of desert type,143 were positive(90.5%).There was significant difference between the two types.In residents living in the areas prevailing of anthropologic type kala-azar,the positive rate of rK39-ELISA in persons with anamnesis of kala-azar were from 42.7% to 59.3%,while in people without anamnesis of kala-azar were from 2.2% to 5.8%.Of 18 persons with positive of rK39-ELISA and negative of Montenegro test,4 appeared symptoms and were diagnosed as kala-azar after 4 to 6 months following up investigation.The antibody of rK39 was positive in 94.6% patients cured for two years and 82.5% remained positive after 9 years.Conclusion rK39 dipstick has high value on the diagnosis of kala-azar in Xinjiang for its easy keep and carry.It is suitable for application in countryside for its simple to operate.It could found the patient at the latent stage.Therefore,it may be used as a screening tool for early diagnosis of kala-azar on the people who were negative with Montenegro test.However,it was not adapt to evaluate the effect of treatment for rK39 antibody existing in the serum of the patients after cured for a long time.