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頁籤選單縮合
題名 | A Review and Comparison of Malaria Diagnostic Tests=瘧疾診斷檢測之回顧與比較 |
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作者姓名(中文) | 李佩紋; 蕭孟芳; | 書刊名 | 光田醫學雜誌 |
卷期 | 2:4 2007.09[民96.09] |
頁次 | 頁57-64 |
分類號 | 415.2901 |
關鍵詞 | 瘧疾; 血球橙黃層螢光染色法; 快速診斷方法; 聚合酶鏈反應; Malaria; Quantitative buffy coat; QBC; Rapid diagnostic tests; RDTs; Polymerase chain reaction; PCR; |
語文 | 英文(English) |
中文摘要 | 世界衛生組織指出早期診斷是瘧疾防治中最重要的環節之一,具有瘧疾診斷潛力的方法包括臨床診斷及(或)實驗室研究分析,可應用於特定環境領域的流行病學調查。週邊血液抹片是瘧疾感染診斷的黃金標準,診斷時通常血液厚片及薄片都要備齊,厚片是用來鑑定有無瘧原蟲存在,而薄片則是進一步鑑定其感染瘧原蟲之種類。其它方法還有利用螢光呈色(fluorochromes)的血球橙黃層螢光染色法(quantitative buffy coat;簡稱是QBC),離心後的瘧原蟲在帶有浮標的毛細管內為被覆的二苯咇啶橘黃染劑(acridine orange)染色,其優點是快速,敏感度高,這在瘧疾流行區低寄生蟲血症的病例診斷尤其重要。QBC的敏感性和血液厚片相似(可達10隻寄生蟲/微升),對低寄生蟲血症病例的瘧疾篩檢時很有幫助。抗原捕捉方法(antigen capture methods)或被稱為快速診斷方法(rapid diagnostic tests;簡稱RDTs)的原理是檢測瘧原蟲產生的專一抗原(蛋白質),這些抗原會出現在已感染者的血液中及最近被感染病人的血液中。富含組氨酸蛋白-2(Histidine-rich protein-2)及寄生蟲專一的乳酸去氫?常在檢測中被當成指標抗原。理想情況下,RDTs的敏感度可與血液薄片相似(100隻/微升),然而當以RDTs作為篩檢時,RDTs陽性反應者應與再以顯微鏡檢測確認之。聚合?連反應(polymerase chain reaction., 簡稱PCR)可檢測瘧原蟲的核酸,其原理是將特定基因序列複製擴增,其敏感度不但可檢測出單隻瘧原蟲,且在混合感染的情況下,各種瘧原蟲皆可被鑑定出來。然而PCR花費昂貴且需在專門的實驗室操作。當病例被高度懷疑為瘧疾而傳統檢測方法卻無法證實為瘧疾感染,或是感染瘧原蟲的種類難以確定時,PCR對診斷很有幫助。 |
英文摘要 | The World Health Organization declared an early diagnosis as one of the most important steps to fight malaria. The potential uses of malaria diagnostic tests range from the clinical and/or research laboratory to epidemiological surveys, in a field environment. Peripheral smear study for malarial parasites is the gold standard in diagnosing malarial infection. Thick and thin smears are usually prepared. Thick smears are used to identify the parasites and thin smears for identifying the species. Another microscopic method, based on fluorochromes, the quantitative buffy coat (QBC) analysis which uses acridine orange staining of centrifuged parastites in capillary tube containing a float, has its advantages in terms of speed, sensitivity and ease, especially in an endemic area where the level of parasitemia is low. QBC has a sensitivity similar to that of thick films (10 parasites/ul) and is helpful for the malaria screening when parasitemia is low. The antigen capture methods or called rapid diagnostic tests (RDTs) detect specific antigens (proteins) produced by malaria parasites. These antigens are present in the blood of infected or recently inflected people. Histidine-rich protein-2 and parasite-specific lactate dehydrogenase are the two antigens currently used for the diagnositec tests. When in good condition, RDTs can achieve a sensitivity similar to that commonly achieved by microscopy in thin films (100 parasites/I). However, when RDTs are employed, they should be sued exclusively as a complement to microscopy. Malaria parasite nucleic acids are detected using polymerase chain reaction (PCR) which amplifies specific gene sequences, not only permits a single parasite to be detected but also allows each Plasmodium species present to be identified, even incases of mixed infection. However, it is expensive, and requires a specialized laboratory. PCR techniques may be useful in selected cases, often when malaria is already strongly suspected, but traditional laboratory tests fail to confirm the diagnosis, or in cases where identification of species is particularly difficult. |
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