Comparative study on the diagnosis of serial herpes simplex virus encephalitis between quantitative chemiluminescence assay and quantitative polymerase chain reactions.

目的：通过比较化学发光法（CL）和两种不同的敏感聚合酶链反应（pcr）对单纯疱疹病毒性脑炎（HSVE）的诊断进行前瞻性研究。方法：材料包括31例疑似HSVE急性脑炎患者的53例脑脊液。每个脑脊液被分配到三个独立的实验室，分别用CL、低灵敏度（单次）PCR和高灵敏度（巢式）PCR进行定量测定。CL提供了一种检测HSV本身和由病毒成分蛋白组成的具有HSV抗原性的小片段的方法。该系列csf分别包括来自11例由HSV-1引起的HSVE患者的24份样本和来自20例非HSVE患者的29份样本。结果-从第3天到第25天，所有HSVE样本（除了一个）的CL显示为50至48,000 pfu/ml。低敏感PCR仅在6个HSVE样本中显示50至47,000 pfu/ml。高s…More sensitivity的PCR结果显示，在11份HSVE样本中，HSVE拷贝数小于100 ~ 120,000拷贝/ml。急性期（1 ~ 7 d） CL和高敏PCR的敏感性为100%，低敏PCR的敏感性为75%。急性期15 ~ 32 d后，CL的敏感性显著高于两种pcr。三种方法的特异性和阳性预测值均为100%。但CL的阴性预测值显著高于低敏感PCR。与高敏感PCR相比，氯代荧光定量值的增加与线性回归相关。结论——急性期CL的敏感性与高敏感PCR相当，急性期后CL的敏感性明显高于高敏感PCR。不同pcr在灵敏度上存在明显差异。PCR、化学发光试验和血清学抗体诊断相结合是目前临床诊断HSVE最有效的方法。少

Objective- A prospective study was undertaken on the diagnosis of herpes simplex encephalitis (HSVE) by comparing chemiluminescence assay (CL) and two different sensitive polymerase chain reactions ( PCRs).Methods- The materials comprised 53 serial cerebrospinal fluid (CSF) samples from 31 acute encephalitis patients with suspected HSVE. Each CSF was distributed to three independent laboratories to perform quantitative measurements by CL, the low sensitive (single) PCR, and high sensitive (nested) PCR. CL provided a method of detecting HSV itself and the small fragment with HSV antigenicity which was composed of viral component proteins. The serial CSFs were found retospectively to comprise 24 samples from 11 patients with HSVE due to HSV-1 and 29 samples from 20 patients with non-HSVE.Results- CL revealed 50 to 48,000 pfu/ml in all samples of HSVE (except one) taken from the 3rd to 25th day. The low sensitive PCR demonstrated 50 to 47,000 pfu/ml in only six samples of HSVE. The high s … More ensitive PCR revealed less than 100 to 120,000 copies/ml in 11 samples of HSVE. At the acute stage from the 1st to 7th day, the sensitivities of CL and the high sensitive PCR were 100%, but that of the low sensitive PCR was 75%. The sensitivity of CL was significantly higher than thoses of both PCRs after the acute stage on the 15th to 32nd day. The specificities and positive predictive values of the three methods were 100%. However, the negative predictive value of CL was significant higher than that of the low sensitive PCR. The increase in quantitative values by CL versus that by the high sensitive PCR was correlated by linear regression.Conclusions- The sensitivity of CL is equivalent to that of the high sensitive PCR during the acute stage, significantly higher than that of the high sensitive PCR after the acute stage. A clear difference in sensitivity exists between the different PCRs. A combination of the PCR, chemiluminescence assay, and serological antibody diagnosis is currently considered the most effective approach for the clinical diagnosis of HSVE. Less