白念珠菌恒温扩增法的建立及其应用价值
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国家自然科学基金(81472032);上海市卫生系统优秀人才培养计划(2017BR032);上海市浦东新区卫生系统重点学科(PWZxk201709)。


Establishment and applicationin in Candida albicans loop-mediated isothermal amplification.
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    摘要:

    目的 建立一种简单快速检测白念珠菌的环介导等温扩增技术(LAMP),并评价其临床价值。方法 采用Primer Explorer V5软件,针对白念珠菌RPS0基因设计4条引物,对LAMP反应体系和反应条件进行优化,评价检测特异性和最低检测限;收集123例VVC组和42例体检组的女性阴道拭子,平行进行真菌培养、LAMP检测、PCR检测、10%KOH镜检,真菌培养作为VVC诊断参考方法;组间检测方法阳性率的比较采用Pearson 2检验,LAMP、PCR、镜检与培养法的一致性采用Kappa检验,P<0.05为差异有统计学意义;应用ROC曲线分析法评价LAMP、PCR在VVC诊断中的价值。结果 LAMP技术的最适反应温度为61°C,且特异性高,与其他常见菌株无交叉反应,检测下限为103 copies/ul;VVC组和体检组的LAMP、PCR、镜检阳性率有统计学差异(LAMP,2=68.576; PCR,2=64.918;镜检,2=50.076,P<0.01)。LAMP和PCR与培养法有较好的一致性(κ=0.744,κ=0.720),镜检与培养法有较差的一致性(κ=0.533);LAMP对VVC的诊断敏感性87.62%,特异性88.33%,阳性预测值92.93%,阴性预测值80.30%。LAMP、PCR诊断VVC的曲线下面积分别为0.873、0.888,两者的诊断效能无差异(Z=0.849,P = 0.3956),但LAMP检测时间短于1h。结论 建立了检测白念珠菌的快速可靠、敏感性好、特异性高的LAMP技术。检测时间大大缩短,综合筛查性能优于实验室常规方法,可用于白念珠菌感染的辅助诊断和疗效监控。

    Abstract:

    Objective Establishing a simple and rapid loop-mediated isothermal amplification (LAMP) to detect Candida albicans (CA), and exploring its clinical value in the diagnosis of vulvovaginal candidiasis (VVC). Methods Primer Explorer V5 software was used to design CA LAMP primers ; First, optimizing LAMP test, and then evaluating the detection specificity and the minimum detection limit; Vaginal swabs were collected from 123 VVC patients and 42 healthy patients. Fungal culture, LAMP test, PCR test, and 10% KOH microscopy were conducted in parallel. Fungal culture was used as the reference method for VVC diagnosis; The detection positive rate among two groups was compared by Pearson 2 test. The consistency among LAMP, PCR, microscopy and culture was performed by Kappa test, P<0.05 was considered statistically significant; ROC curve analysis was used to evaluate LAMP test, PCR test. Results LAMP optimum reaction temperature is 61°C; The specificity was high, and there was no cross reaction with other strains; The detection limit was 103 copies/ul. LAMP, PCR and 10%KOH among the VVC group and the healthy group were statistically significant (LAMP,2=68.576;PCR,2=64.918;microscopy,2=50.076,P<0.01); LAMP detection and PCR have good consistency (κ=0.744,κ=0.720), microscopy examination have poor consistency (κ=0.533); The area under the curve of LAMP and PCR microscopy was 0.873 and 0.888, respectively. No difference in efficacy between LAMP and PCR(Z = 0.849, P = 0.3956), but the LAMP lowest detection is shorter than 1h. LAMP has a diagnostic sensitivity of 87.62%, specificity of 88.33%, positive predictive value of 92.93% and negative predictive value of 80.30%. Conclusion A rapid, reliable, sensitive and specific LAMP technique for detecting Candida albicans was established. The turnround time is greatly shortened, and the comprehensive screening performance is superior to the laboratory routine method. LAMP can be used for the supplementary diagnosis and therapeutic effect monitoring in Candida albicans infection.

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肖晶晶,王丽娟,孔继烈,方雪恩,吴文娟.白念珠菌恒温扩增法的建立及其应用价值[J].临床检验杂志,2019,(1):5-10

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  • 收稿日期:2018-10-15
  • 最后修改日期:2019-01-24
  • 录用日期:2019-01-10
  • 在线发布日期: 2019-08-13
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