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肺炎支原体检测时,为什么未致敏粒子孔阳性了?

时间:2019-03-05       作者:检验视界网      浏览量:4284 次

作者:雨果,西安交通大学第二附属医院检验科


周末值班,学生先看的肺炎支原体抗体的检测结果,看完疑惑了,问我为什么3号标本的未致敏粒子孔竟然呈阳性反应?未致敏粒子不应该是阴性的不凝集状态么?原图截图后如下

 

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发现问题、解决问题,在解决问题的过程中去体会临床检验工作。那么究竟什么原因呢?又该如何解决呢?


话要从方法说起。


采用赛乐迪亚-MICROⅡ试剂盒应用在很多临床实验室,用以半定量检测肺炎支原体,辅助诊断肺炎支原体感染。


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赛乐迪亚试剂的检测原理是凝集法,用肺炎支原体(Mac株)细胞膜成分致敏人工明胶粒子,致敏粒子与人血清中存在的肺炎支原体抗体发生凝集反应。


其操作,用过的人其实都很熟悉,图谱也比文字更加直观。

 

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在结果判定时,一些原则却是经常被人忽略的。


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判读结果的前提是:

(1)和样本同步进行的试剂对照,无论是致敏粒子还是未致敏粒子均是阴性(-);

(2)和样本同步进行的阳性对照是1:320阳性;

(3)每个样本的未致敏粒子孔均是阴性;


在这三个前提下,确定了血清稀释液、致敏粒子、未致敏粒子都是有效的;


然后看样本孔,并做出判断:

(1)样本未致敏粒子孔阴性(-),第3孔致敏粒子孔1:40阴性(-),样本肺炎支原体抗体为阴性;

(2)样本未致敏粒子孔阴性(-),第3孔致敏粒子孔1:40阳性(+),样本肺炎支原体抗体为阳性,并报告(+)时的最终稀释倍数作为抗体滴度。

这样的判定很常见,不常见的是另一种,也就是在文章一开始提到的那一种,那就是当未致敏粒子孔为阳性或者弱阳性的时候又该怎么办呢?

(3)由于非特异性抗体干扰,样本未致敏粒子孔阳性(+)或弱阳性(±)时,第3孔致敏粒子孔1:40阴性(-),则样本肺炎支原体抗体仍为阴性;

(4)由于非特异性抗体干扰,样本未致敏粒子孔和致敏粒子孔均呈阳性(+)或弱阳性(±)时,应对样本进行吸收试验;


于是乎,我们对这一样本进行了吸收实验,也让同学们借此明确了吸收实验是怎样一回事。


吸收试验的重点在吸收二字;首先是血清和未致敏粒子按照1:9比例混匀,并在室温下孵育30分钟,然后离心取出上清液50微升加入第二孔,第三空之后每孔加入25微升血清稀释液;从第二孔中吸出25微升到第三空依次如前所述进行对倍稀释,最后加入未致敏粒子和致敏粒子,室温静置3小时观察结果即可。


最终3号样本经过吸收实验后,证实结果为阴性??赡苡捎谝恍┓翘匾煨钥固宓拇嬖诙斐晌粗旅袅W涌缀椭旅袅W涌站氏殖鲅粜曰蛘呷跹粜越峁?。


小问题背后往往都是大故事,检验专业内容庞杂、涉及面广,不放过任何一个环节,就总是收获满满的。


检验视界网独家首发,转载请注明来源及作者!






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