蛋白免疫印迹试验在HIV确证检测中的漏检及原因分析

目的探讨蛋白免疫印迹试验（WB）在艾滋病病毒（HIV）确证检测过程中的漏检问题,可能的原因及解决方法。方法 40份酶联免疫吸附试验（ELISA）和（或）胶体金法筛查阳性、WB实验确证阴性的样本,分析其来源、S/CO值,并进行抗体追踪复检。结果 40份样本中检出9份HIV阳性,28份阴性,3份样本流失。阴性者均来源于没有高危行为的普通人群,其中无偿献血人群13份,ELISA S/CO均〈3。9份阳性样本中,6例为男男性行为人群（MSM）,自愿咨询检测（VCT）3例。其中ELISA S/CO值〈6的5例,〉10的4例,6例最后考虑为窗口期感染,3例可能为WB试剂中反应膜出现问题。结论 WB检测漏检,可能是样本处于窗口期感染或试剂反应膜问题,实验室应综合分析筛查阳性而WB确证阴性的检测样本,要进行追踪检测,以确定其真实的HIV-1感染状况,防止漏检。

Analysis of misdetection and its causes in WB assay of HIV confirmatory test

Objective To investigate the misdetection of HIV western blotting （WB） test, and its possible reasons and solutions. Methods Forty specimens with positive HIV screening test but negative WB test were analyzed for sources and S/CO value, and followed up. Results Among 40 specimens, 9 were positive confirmed by WB, 28 were negative, 3 were lost. All negative specimens were from general population with no highrisk behaviors, of whom 13 came from unpaid blood donors with S/CO values below 3. Of 9 positive samples, 6 came from men who have sex with man （MSM）, 3 from voluntary counseling and testing（VCT）. There were 5 cases with S/CO value below 6 and 4 cases with S/CO value above 10 by ELISA. Six cases were diagnosed as window period infection finally and 3 cases were attributed to reactive bands of WB. Conclusion The misdetection of WB may be caused by window period infection or reagent reaction bands, so we should comprehensively analyze samples of ELISA positive but WB negative, follow up to determine the real HIV-1 infection status.