麻疹实验室诊断中病毒抗原与RNA检测的对比研究

目的：单克隆抗体检测麻疹病毒抗原与一步法RT-PCR检测麻疹病毒RNA在实验室诊断中的对比。方法收集疑似麻疹患者咽拭子标本。出疹3 d后血清抗麻疹病毒IgM抗体阳性者咽拭子纳入对比试验。用荧光标记的鼠抗麻疹病毒单克隆抗体检测标本中麻疹病毒抗原成份;用一步法RT-PCR结合Taqman技术检测麻疹病毒RNA成份。结果82份疑似麻疹患者抗麻疹病毒IgM抗体阳性率81.71%（67/82）。67例确诊病例标本单克隆抗体间接免疫荧光阳性率88.06%（59/67）;一步法RT-PCR结果阳性率98.51%（66/67）。结论麻疹病毒RNA的一步法RT-PCR结合Taqman检测敏感性高于其抗原的间接免疫荧光检测。     

经直肠与经会阴途径穿刺活检诊断前列腺癌的对比分析

目的比较经直肠途径与经会阴途径穿刺活检对前列腺癌(PCa)的检出率。方法回顾性收集128例首次确诊的PCa患者,根据活检途径不同,分为经直肠途径组62例和经会阴途径组66例,比较2种途径诊断不同总前列腺特异性抗原(TPSA)水平PCa及临床意义前列腺癌(CsPCa)检出率的差异。对其中104例(经直肠途径组42例,经会阴途径组62例)在常规超声检查基础上行CEUS,于83例(经直肠途径组28例,经会阴途径组55例)检出阳性病灶后行靶向穿刺,比较2组系统穿刺及靶向穿刺PCa、CsPCa的检出率。结果经直肠途径组PCa检出率为35.48%(22/62),CsPCa检出率为25.81%(16/62);经会阴途径组PCa检出率为42.42%(28/66),CsPCa检出率为28.79%(19/66),差异均无统计学意义(P=0.471、0.676);2组对不同TPSA水平PCa及CsPCa的检出率差异均无统计学意义(P均0.05)。经直肠途径组与经会阴途径组在系统穿刺中PCa检出率[35.48%(22/62) vs 40.91%(27/66);P=0.587]、阳性针数/总针数[14.25%(106/744) vs 14.52%(115/792);P=0.879]、CsPCa检出率[25.81%(16/62) vs 28.79%(19/66);P=0.676]差异均无统计学意义;靶向穿刺活检PCa检出率[35.71%(10/28) vs 14.55%(8/55);P=0.002]、阳性针数/总针数[30.77%(24/78) vs 6.76%(10/148);P0.001]差异有统计学意义。结论超声引导下前列腺穿刺活检经直肠途径与经会阴途径对PCa及CsPCa检出率无差异。CEUS可引导前列腺靶向穿刺活检,穿刺操作时选择与CEUS相同的患者体位及解剖断面可提高PCa检出率。     

儿童扁桃体及腺样体术前表面细菌培养结果与术后发热相关性分析

目的:分析因阻塞性睡眠呼吸暂停低通气综合征(OSAHS)而需要行手术的患儿,术前腺样体及扁桃体表面的细菌培养结果与术后发热的关系.方法:随机抽取诊断为OSAHS并拟行腺样体及扁桃体手术的患儿60例,于术前采用咽拭子法,取扁桃体、腺样体表面分泌物进行细菌培养,采用低温等离子消融系统实施腺样体切除+扁桃体部分切除手术,观察并记录其术后体温的变化.将术前细菌培养阳性组与阴性组患者术后发热情况进行比较.结果:细菌培养结果以正常菌群为主,扁桃体及腺样体检出率分别为96.7％(58/60例)及78.3％(47/60例);条件致病菌以金黄色葡萄球菌、肺炎链球菌为主,其在扁桃体的检出率分别为28.3％(17/60例)和11.7％(7/60例),在腺样体的检出率分别为26.7％(16/60例)和16.7％(10/60例);术前细菌培养阳性组与阴性组比较,两组术后发热率差异无统计学意义(P=0.052).结论:儿童扁桃体及腺样体术前细菌培养阳性与术后发热无关.     

多通道分子信标聚合酶链反应在新生儿侵袭性念珠菌感染快速诊断中的应用

目的初步建立新生儿侵袭性真菌感染（IFI）常见念珠菌的多通道分子信标荧光聚合酶链反应（MQ-PCR）检测体系，实现新生儿IFI病原体的早期检出，并探讨患儿不同部位念珠菌检出率的差异。 方法收集2018年1月至2019年4月首都医科大学附属北京妇产医院收治的34例临床诊断为脓毒败血症并疑似IFI新生儿的血液、深部痰液和咽拭子标本；常规行血培养及微生物鉴定，并应用MQ-PCR体系对3类标本进行念珠菌检测，比较两种方法念珠菌阳性检出率和检测时长。 结果本研究MQ-PCR体系检测白色念珠菌、近平滑念珠菌、光滑念珠菌和热带念珠菌的检出下限均为50 FU/ml，线性检测范围为5 × 10¹～1 × 10⁵ CFU/ml，且MQ-PCR体系所检出细菌与其他14种常见致病性细菌或DNA序列同源性较高的真菌无交叉反应。9例（9/34、26.5%）患儿经血培养念珠菌阳性确定为IFI；此9例IFI患儿同一血液样本、自身不同部位（深部痰液、咽拭子）样本行MQ-PCR均检出念珠菌阳性，且检出菌种与血培养完全一致。比较血标本两种方法念珠菌阳性检出率：血培养法为26.5%（9/34），MQ-PCR为32.4%（11/34），差异无统计学意义（χ² = 0.5、P = 0.5）。血培养法念珠菌阳性检出率（26.5%）和相应的自身不同部位标本MQ-PCR法念珠菌阳性检出率差异均无统计学意义（P均> 0.05），其中咽拭子、深部痰液和血标本中念珠菌阳性检出率分别为41.2%（14/34）、32.4%（11/34）和32.4%（11/34）。MQ-PCR检测血液、深部痰液和咽拭子标本时长分别为3.5（3.2，3.9）h、3.1（2.9，3.2）h和2.7（2.5，2.9）h，较血培养时长[94.0（78，105.8）h]显著缩短，差异均有统计学意义（Z =－2.7、P = 0.008，Z =－2.5、P = 0.013，Z =－2.7、P = 0.008）。 结论对IFI新生儿多部位标本应用MQ-PCR检测念珠菌，较血培养具备高符合率及快速检出的优点，利于新生儿念珠菌定植及血流感染的早期诊断及动态监测。     

85例巨细胞病毒感染婴幼儿的临床特征

目的探讨婴幼儿巨细胞病毒(CMV)感染的临床特点、治疗及预后。方法回顾性分析十堰市中医院住院治疗的85例婴幼儿CMV感染的临床资料,对该疾病的临床特点、治疗及预后进行总结。结果 85例患儿年龄9 d~3岁,≤6个月患儿占83.5%(71/85);农村和城市分布分别占78.8%和21.2%;母乳喂养、混合喂养及人工喂养分别占70.6%、21.2%和8.2%。临床表现为肺炎者60例(70.6%);婴儿肝炎38例(44.7%),无黄疸型为12例(14.1%),黄疸型为26例(30.6%)(其中胆汁瘀滞型10例、肝硬化1例、胆道闭锁2例);心肌损害9例(10.6%);贫血7例(8.2%),血小板(PLT)减少或升高7例(8.2%);脑发育异常者6例(7.1%),听力受损者3例(3.5%)。血清CMV-IgM阳性患儿46例(54.1%),血清CMV DNA阳性(≥500拷贝/ml)患儿35例(41.2%),尿CMV DNA阳性者62例(72.9%)。不同年龄组患儿肝功能损害、黄疸及肺炎的发生率差异均具有统计学意义(χ~2=10.17、P=0.017,χ~2=10.10、P=0.017,χ~2=26.00、P0.001),而贫血、PLT计数异常、心肌损害、脑发育异常及听力受损的发生率差异均无统计学意义(P均0.05)。治疗后好转72例,放弃治疗10例,死亡3例。结论婴幼儿感染CMV多发生在年龄≤6个月、居住在农村及母乳喂养者,临床表现多样化,以肺炎和肝炎多见;大多数CMV感染者抗病毒治疗疗效显著,少数预后较差甚至死亡。     

经腹腔途径腹腔镜前列腺癌根治术后切缘阳性的影响因素分析

目的探讨经腹腔途径腹腔镜前列腺癌根治术后切缘阳性的相关影响因素。方法 2009年9月至2014年5月,采用经腹腔途径行腹腔镜下前列腺癌根治术61例。患者年龄56~74岁,平均71岁。术前均经直肠超声引导下穿刺病理证实前列腺癌诊断。通过回顾性研究了解术前血清前列腺特异性抗原(PSA)、穿刺后Gleason评分、穿刺针数阳性百分率,术前TNM分期对手术切缘阳性的影响。结果61例前列腺癌患者术后切缘阳性率19.7%(12/61),病理分期与手术切缘阳性成正相关(γ=0.311,P=0.001),且对手术切缘阳性有统计学意义(χ~2=16.32,P=0.001);对于手术切缘阳性率,术前血清PSA20ng/ml组与血清PSA≥20ng/ml组比较,差异有统计学意义(χ~2=7.32,P=0.007);穿刺后Gleason评分7分组与Gleason评分≥7分组差异无统计学意义了(χ~2=1.43,P=0.23);穿刺针数阳性百分率,50%组与≥50%组差异有统计学意义(χ~2=4.32,P=0.017)。结论穿刺后TNM分期,血清PSA水平,穿刺阳性百分率的差异对手术切缘阳性有统计学意义。前列腺癌穿刺标本Gleason评分与术后病理切缘之间无相关性。     

两种血清学方法对儿童肺炎支原体感染抗体测定的临床评价

目的探讨被动凝集法和间接免疫荧光法在肺炎支原体早期诊断中的应用价值。方法采用PA法和IFA法分别对236例笔者所在医院儿科疑似MP感染的初诊患者进行血清抗-MP抗体的测定。结果 236例患儿中,用PA法检测阳性94例（阳性率39.8%）,IFA法测定阳性125例（阳性率53.0%）,两种方法的阳性检出率比较,差异有统计学意义（x2=4.1,P〈0.05）。结论 PA法和IFA法均对MP感染的早期诊断具有重要的参考价值,联合检测可提高MP感染确诊率。     

G试验对HIV/AIDS患者合并侵袭性真菌感染的诊断价值

目的研究G试验和真菌培养法对人类免疫缺陷病毒感染者/获得性免疫缺陷综合征(HIV/AIDS)患者合并侵袭性真菌感染的诊断价值。方法收集本院2015年6月至2016年5月入院于临床出现真菌感染症状的HIV/AIDS患者共1 423例,取其静脉血行(1,3)-β-D-葡聚糖检测的同时,留取血液或骨髓、痰、灌洗液、咽拭子、脑脊液以及粪便等标本行真菌培养;通过回顾性研究,了解使用抗真菌药后患者临床症状是否缓解作为临床诊断标准,并以此为标准比较两种检测方法的差异。结果1 423例患者中使用抗真菌药物后症状缓解588例为侵袭性真菌感染(IFI)组使用抗真菌药物后症状未缓解者835例为非IFI组。以100.5 pg/ml为临界值阳性,G试验阳性患者527例,阴性患者896例,准确度达91.36%;而以90.5 pg/ml、110.5 pg/ml或120.5 pg/ml为临界值阳性时准确度分别为89.88%、90.51%和89.18%;真菌培养阳性患者636例,阴性患者787例。IFI组及非IFI组患者G试验含量分别为(532.83±778.67)pg/ml和(44.14±35.08)pg/ml,两组差异具有统计学意义(t=15.208、P0.001);IFI组患者中念珠菌感染者、马尔尼菲青霉菌感染者、隐球菌感染者、念珠菌及马尔尼菲青霉菌混合感染者G试验含量分别为(444.29±705.44)pg/ml、(452.78±511.40)pg/ml、(89.56±71.58)pg/ml和(596.28±840.23)pg/ml,隐球菌感染者G试验含量分别与念珠菌感染者(t=6.581、P0.001)、马尔尼菲青霉菌感染者(t=6.889、P0.001)和念珠菌及马尔尼菲青霉菌混合感染者(t=4.865、P0.001)比较,差异均具有统计学意义。G试验及真菌培养法的敏感度分别为84.35%和70.75%,差异具有统计学意义(χ2=5.331、P=0.021);特异度分别为96.29%和73.65%,差异具有统计学意义(χ~2=20.067、P0.001);两方法联合检测后敏感度为96.43%,特异度为70.54%。结论 HIV/AIDS患者合并IFI诊断方面G试验较真菌培养法简便、快速、阳性率高、特异性也较高,连续监测G试验更有助于提高IFI诊断效率;两者联合检测可提高肺孢子菌及隐球菌的诊断效率,早期预测及确诊马尔尼菲青霉菌感染     

直肠充气MSCT检查对直肠癌术前分期的诊断价值

目的 探讨直肠内充气MSCT检查在直肠癌术前肠系膜浸润及淋巴结转移分期中的临床诊断价值.方法 选择2010年1月至2010年7月期间辽宁医学院附属第一医院68例经手术病理证实的直肠癌患者,术前行直肠内充气MSCT检查,以术后病理结果作为金标准,比较直肠内充气MSCT在诊断肠系膜浸润及淋巴结转移方面的准确性、敏感度、特异度、阳性预测值及阴性预测值.结果 直肠内充气MSCT扫描患者的直肠及乙状结肠充分扩张,直肠周围脂肪间隙与相对较高密度的肠壁及极低密度肠腔对比清晰.直肠内充气MSCT对直肠癌肠系膜浸润Ⅰ、Ⅱ、Ⅲ度的准确性分别为92.6(63/68)、91.1%(62/68)及95.6%(65/68),敏感度分别为91.2%(31/34)、85.0%(17/20)及92.9%(13/14),特异度分别为94.1%(32/34)、93.8%(45/48)及96.3%(52/54),阳性预测值分别为93.9%(31/33)、85.0%(17/20)及86.7%(13/15),阴性预测值分别为91.4%(32/35)、93.8%(45/48)及98.1%(52/53);直肠癌肠系膜淋巴结转移N0、N1、N2分期的准确性分别为92.6%(63/68)、85.3%(58/68)及92.6%(63/68),敏感度分别为86.2%(25/29)、90.0%(27/30)及66.7%(6/9),特异度分别为97.4%(38/39)、81.6%(31/38)及96.6%(57/59),阳性预测值分别为96.2%(25/26)、79.4%(27/34)及75.0%(6/8),阴性预测值分别为90.5%(38/42)、92.1%(35/38)及95.0%(57/60).结论 直肠内充气MSCT扫描能够清晰显示直肠癌直肠系膜浸润深度,对肠系膜淋巴结转移术前N分期诊断与病理N分期具有较高的敏感度和特异度,在直肠癌术前分期中有重要的应用价值,可作为术前影像学评估的常规手段,为制定个体化的治疗方案提供指导.     

单发脑转移瘤的18F-FDG PET/CT显像特点

目的探讨单发脑转移瘤的18F-FDG PET/CT显像特点,以提高其诊断准确率。方法回顾性分析62例单发脑转移瘤患者的头部18F-FDG PET/CT显像资料,根据最大径将病灶分为1.0cm和≥1.0cm 2组,采用χ2检验比较2组病灶的瘤周水肿及18F-FDG摄取情况。依据CT表现将病灶分为高密度结节、等密度结节及囊性密度结节3种形式,采用χ2检验分析不同CT表现形式病灶的18 F-FDG摄取情况。结果本组62例单发脑转移瘤,发生于幕上52例(52/62,83.87%),幕下10例(10/62,16.13%)。1.0cm和≥1.0cm两组病灶的瘤周水肿差异有统计学意义(χ2=7.414,P=0.006),而18F-FDG摄取差异无统计学意义(χ2=2.647,P=0.104)。不同CT表现形式18 F-FDG摄取情况差异有统计学意义(χ2=14.480,P=0.001);大部分(11/12,91.67%)高密度结节型的病例18 F-FDG摄取不超过2级;而等密度结节型18F-FDG摄取均不低于1级,并以3级居多(17/34,50.00%);56.25%(9/16)的囊性密度结节型表现为18 F-FDG无摄取。结论单发脑转移瘤的18 F-FDG PET/CT表现形式多种多样,掌握其18 F-FDG PET/CT显像特点,有助于提高诊断准确率。     

Chlamydia trachomatis antigen can be detected in the urine sample of men with non-gonococcal urethritis

Summary We tested the first portion of voided urine (FVU) and urethral swab from 80 patients with nongonococcal urethritis (NGU) using a novel enzymeamplified immunoassay (IDEIA) for the detection of Chlamydia trachomatis antigen. Urine specimens were positive in all patients with positive urethral swabs (positive coincidence ratio, 100%) and in 6 of 54 patients with negative swabs (negative coincidence ratio, 88.9%). Our data suggest that FVU is suitable for the detection of Chlamydia trachomatis antigen using the IDEIA test in patients with NGU.     

广州地区484例登革热患者血清学检测及病毒分离株E基因序列分析

目的对2006年广州地区登革热患者的血清进行检测,并对分离的病毒株进行E基因序列分析,以了解可能的传播来源。方法用免疫层析法（ICT）检测患者血清登革病毒IgM和IgG抗体,并用酶联免疫吸附试验（ELISA）检测登革病毒非结构蛋白1（NS1）抗原和IgM抗体;C6／36细胞微量法对发病2d内患者的血清进行登革病毒的分离培养,并用免疫荧光检测（IFA）及RT—PCR法对病毒分离株进行鉴定;测定分离株DVI—GZ42／06的E基因序列,与国内外参考株、流行株进行同源性比较并构建系统进化树。结果ICT法检测患者登革病毒IgM和IgG的检出率分别为89．5％（433／484）及38．0％（184／484）。ELISA法检测患者血清NS1抗原的检出率为：第1～2天92．7％（38／41）、第3～5天83．3％（70／84）、第6～10天10．9％（5／46）;IgM抗体的检出率分别为2．4％（1／41）、51．2％（43／84）及97．8％（45／46）。病毒分离培养阳性率为61．0％（25／41）,IFA及RT—PCR法证实为登革1型病毒。分离株Guangzhou／42／06的E基因序列与登革1型病毒标准株Hawaii／45的核苷酸同源性为94．6％;与Thailand／NI09VI04、Vietnam／06和Vietnam／07的同源性高,分别为99．0％、98．6％和98．6％,且处于同一进化分支上,亲缘关系很近,而与广东省2006年前分离株亲缘关系较远。结论登革病毒NS1抗原检测在登革病毒感染的早期诊断中有重要价值。2006年广州地区出现的登革热疫情由输入性病例引起本地暴发流行的可能性大。     

Routine throat swabs in artificially ventilated patients: meaningful bacteriologic monitoring or a needless procedure?

Organisms colonizing the oropharynx of patients in the intensive care unit (ICU) play an important role in the development of nosocomial infection. Thus, routine throat swab specimens of ICU patients are recommended to screen for potential pathogens [20]. This investigation was designed to clarify the value of throat swabs taken in addition to tracheal aspirates, urine cultures, and wound swabs with regard to antibiotic therapy in patients with pneumonia and other infections. MATERIALS AND METHODS. A total 627 intubated patients were examined in a surgical ICU during a 12 month period. Pharyngeal swabs, tracheal aspirates, urine cultures, and-if necessary-swabs from wounds and drains were taken immediately after admission to the ICU and routinely thereafter three times each week. Definitions: Early onset pneumonia: pneumonia occurring within 4 days; late onset pneumonia: pneumonia occurring after the 4th day. Intra-abdominal infection: diffuse or localized peritonitis or abdominal abscess. Wound infection: soft-tissue or bone infection. Corresponding organisms: the same species of bacteria with the same sensitivity pattern (Table 1). RESULTS. Sixty-eight of the patients developed pneumonia. 37 had early onset pneumonia. In 22 of these patients, throat and tracheal specimens had been obtained 2-3 days before the pneumonia was diagnosed. In these specimens, the causative organisms for the subsequent pneumonia were isolated in the throat in 60% of cases and in tracheal secretions in 40% (Table 3). In 35 patients with late onset pneumonia, the causative bacteria were found in 66% of the cases in the throat swabs obtained 2-3 days before the diagnosis was made, in tracheal aspirates in 74% (Table 4). Throat swabs obtained at admission to the ICU from already infected patients or from patients who developed an infection were significantly more colonized with potentially pathogenic micro-organisms (Fig. 1). In 4 patients with early onset pneumonia the results of the throat swab cultures influenced antibiotic therapy, but none of the throat culture results influenced the therapy of the patients with late onset pneumonia or other infections (intra-abdominal infection, wound infection, urinary tract infection). CONCLUSIONS. The throat swab taken at admission may indicate patients at risk for infection. However, throat cultures taken routinely thereafter, parallel with tracheal aspirate cultures, do not provide additional information that is diagnostically or therapeutically helpful. Therefore, throat swab cultures are not necessary for routine bacteriological monitoring. For the prevention of colonization by local administration of antimicrobial agents, regular throat cultures are mandatory.     

Urine as an alternative to urethral swabs for the diagnosis of Chlamydia trachomatis in infertile males

Swabbing the urethrae of men has been the traditional approach for collecting specimens for detection of Chlamydia trachomatis . Recently, however, urine testing using enzyme immunoassay has yielded promising results. A total of 105 patients attending the Andrology Clinic at Ga Rankuwa Hospital, Medunsa were included in the study. These patients were asymptomatic and had no urethral discharge. Three endo-urethral swabs and first-catch urine were collected fiom each patient. The urethral swabs were used for enzyme immunoassay (EIA) (IDEIA 111), tissue culture and direct immonufluorescent antibody (DFA) test (IMAGEN) to detect C. trachomatis . In addition about 15–30 ml of first-catch urine, or urine collected at least 2h after the previous micturition, was collected for each patient for EIA testing. Fifteen (14.3%) of 105 patients were positive on urethral swab EIA, in comparison with the DFA test in which 14 (13.3%) were positive. Eight (7.8%) were positive in tissue culture. Urine EIA was positive in 17 (16.2%) patients, of whom five (4.8%) were positive in urine EIA only. All EIA positive urines were confirmed by DFA. We recommend that first-catch urine or urine collected at least 2h after the previous micturition in infertile males may be considered a suitable alternative to urethral swab for chlamydial diagnosis because it is noninvasive and nontraumatic.     

Prevalence of Neisseria gonorrhoeae infection in patients attending an antenatal clinic

Neisseria gonorrhoeae infection was diagnosed by culture using a selective medium (Thayer-Martin) in 140 (11.7%) of 1 200 pregnant black women attending an antenatal clinic in 1981. The study confirmed the need for specimens from three sites (endocervix, urethra and rectum)--endocervical cultures were positive in only 75.9% of infected women, in the remainder only the urethral and/or rectal cultures were positive. Rectal cultures were positive in 41.6%. Cultures of throat swabs from 200 women were all negative for N. gonorrhoeae. In comparison with endocervical specimens directly plated, high vaginal swab specimens placed in Stuart's transport medium before plating gave a lower yield of positive cultures. No penicillinase-producing N. gonorrhoeae strains were detected.     

Molecular diagnosis of nasopharyngeal carcinoma: detecting LMP-1 and EBNA by nasopharyngeal swab.

OBJECTIVES: The aim of this study was to investigate the feasibility of molecular diagnosis of nasopharyngeal carcinoma (NPC) by combining nasopharyngeal swab and polymerase chain reaction (PCR) to detect Epstein-Barr virus (EBV) derived latent membrane protein-1 gene (LMP-1) and Epstein-Barr nuclear antigen gene (EBNA). METHODS: 437 adults underwent nasopharyngoscopy, possible biopsy, and nasopharyngeal swab to obtain nasopharyngeal cells for the detection of LMP-1 and EBNA by PCR. RESULTS: By detecting LMP-1 and EBNA in the nasopharyngeal swabs, NPC could be diagnosed with a false-positive rate of 1.7% (6/354), a false-negative rate of 8.6% (6/70), a sensitivity of 91.4% (64/70), a specificity of 98.3% (348/354), positive predictive value of 91.4% (64/70), and negative predictive value of 98.3% (348/354). CONCLUSION: Detecting EBV genomic LMP-1 and EBNA by nasopharyngeal swab verifies NPC with a sensitivity of 91.4% and specificity of 98.3%. The nasopharyngeal swab coupled with PCR based EBV LMP-1 and EBNA detection could serve as a good supplement to pathological diagnosis of NPC.     

Indirect fluorescent antibody testing of nasopharyngeal swabs for influenza diagnosis in lung transplant recipients.

BACKGROUND: Rapid and reliable diagnosis of respiratory viral infections (RVI) in lung transplant recipients is essential to direct therapy of acute graft dysfunction and identify epidemic trends. Traditional techniques of serology and viral culture are limited by the lack of antibody response and delay in diagnosis. METHODS: We examined the clinical utility of indirect fluorescent antibody (IFA) testing in adult lung transplant patients with suspected RVI, compared with serology and culture. Nasopharyngeal and throat swabs (NT) were obtained to sample epithelial cells, followed by application of monoclonal antibody to respiratory syncytial virus, adenovirus, parainfluenza 1-3 and influenza A and B. The Bartels Respiratory Viral Detection kit was used with IFA results available within 24 hours. RESULTS: Nine of 18 patients tested positive for RVI with influenza A (n = 8) and influenza B (n = 1) detected. The sensitivity of IFA (67%) was higher than that of cell culture (45%). With intensive supportive therapy, infection was self-limiting in bronchiolitis obliterans syndrome (BOS) Grade 0-2 patients. However, patients with BOS Grade 3 manifested an acute exacerbation of airflow obstruction, which proved to be irreversible. CONCLUSIONS: Lung transplant patients with "flu-like" symptoms should proceed to IFA testing of NT swab specimens for early diagnosis. Samples collected within 7 days of symptom onset have high sensitivity as compared with serology and viral culture techniques.     

聚乙二醇化干扰素联合利巴韦林治疗慢性丙型肝炎的疗效及影响因素分析

目的：分析聚乙二醇化干扰素（PegIFN）联合利巴韦林治疗对慢性丙型肝炎的疗效及影响因素。方法使用聚PegIFNα-2a（派罗欣180μg/周）联合利巴韦林（根据体重900～1200 mg/d）治疗60例慢性丙型肝炎患者,疗程48周。结果本研究60例慢性丙型肝炎患者中,HCV-Ⅰ型45例,占75%,非HCV-Ⅰ型15例,占25%。HCV-Ⅰ型和非HCV-Ⅰ型患者持续应答（SVR）率分别为60.0%和93.3%,差异具有统计学意义（χ2=6.162,P=0.013）;基线病毒载量,以HCV RNA定量1＆#215;106 IU/ml划分,HCV RNA高水平组和低水平组SVR分别为48.3%和77.3%,差异具有统计学意义（χ2=6.093,P=0.014）。治疗过程中获得快速病毒学应答（RVR）的病例获得SVR和未获得RVR的病例获得SVR的比率分别为84.6%和38.1%,差异具有统计学意义（χ2=9.690,P=0.002）。治疗过程中获得早期病毒学应答（EVR）的病例获得SVR和未获得EVR的病例获得SVR的比率分别为78.4%和11.1%,差异具有统计学意义（χ2=4.036,P=0.045）。结论慢性丙型肝炎患者的治疗过程中,病毒基因型、基线病毒载量以及治疗过程中是否获得RVR/EVR均可能影响治疗后的持续病毒学应答。