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通过测试评估麻风病神经损伤诊断的效果

By LabMedica International staff writers
Posted on 28 Jun 2018
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图片:ABI 7300实时PCR系统(图片蒙应用生物系统公司惠赐)。
图片:ABI 7300实时PCR系统(图片蒙应用生物系统公司惠赐)。
麻风病是麻风分枝杆菌引起的慢性传染病,麻风分枝杆菌是一种专性胞内菌,倾向于感染周围神经和皮肤。麻风病是当前的一种棘手的疾病,因为它仍代表着发展中国家公共卫生的一个问题。
 
虽然近年来麻风病控制取得的进展有目共睹,但是早期鉴定仍是控制计划的首要目标之一。麻风病潜伏期长,症状和迹象隐蔽,因此难以诊断。伴随神经失能的多菌型(MB)病例占大多数,说明到晚期才得到诊断,加剧了许多国家的流行病无效控制。
 
巴西乌贝兰迪亚联邦大学(UFU, www.ufu.br)的科学家及其同事2014至2016年间招募了175名血清阳性和35名血清阴性的与患者有接触的家属,他们要接受一套全面的程序,包括临床评估、分子评估(外周血定量聚合酶链反应(qPCR)、皮肤裂口组织液涂片qPCR、皮肤活检qPCR)和神经肌电图评估。对所有与患者有接触的家属进行酶联免疫吸附测定(ELISA)。针对从麻风分枝杆菌细胞壁提纯的原生PGL-I进行酶联免疫吸附测定(ELISA),检测血清中的抗原酚糖脂I (PGL-I) IgM抗体。用美国加利福尼亚州福斯特市应用生物系统公司(www.appliedbiosystems.com)的ABI 7300实时PCR系统靶向杆菌特异的基因组区(RLEP),进行靶向麻风分枝杆菌DNA的定量实时PCR (qPCR)测定。
 
研究人员发现,血清阳性的家属外周血qPCR的阳性率为40.6% (71/175),而血清阴性的家属外周血qPCR的阳性率仅为8.6% (3/35)。皮肤裂口组织液涂片qPCR只有4% (7/175)的家属杆菌镜检结果呈阳性,而qPCR检测到这个组的阳性率为47.4% (83/175),血清阴性的家属阳性率则为17.1% (6/35)。血清阳性的家属神经损伤的几率是正常的4.04倍。外周血qPCR阳性伴随神经损伤的几率是正常的2.08倍。相反,如果至少存在一个BCG接种瘢痕,则预防神经损伤的效果是原来的2.44倍(OR = 0.41)。
 
该研究的论文发表于2018年5月21日的《公共科学图书馆》杂志《被忽视的热带病》分册(Public Library of Science Neglected Tropical Diseases)。作者总结说,若欲确定未显症状的麻风病人家属神经损伤的几率是否增大,ELISA抗PGL-I是最重要的检验。联用两种测定(ELISA抗PGL-I和外周血qPCR),如果又有BCG瘢痕,或许可以判定得麻风神经病的可能性更大,有利于早期诊断和治疗。
 
Related Links:

乌贝兰迪亚联邦大学>>> www.ufu.br

应用生物系统公司>>> www.appliedbiosystems.com


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