Kistik ekinokokkozisli hastaların serolojik tanısında IHA, ELISA ve immunokromotografik yöntemlerin karşılaştırılması
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Dosyalar
Tarih
2023
Yazarlar
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Yayıncı
Necmettin Erbakan Üniversitesi Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Kistik ekinokokkozis, tarım ve hayvancılığın yapıldığı ülkelerde görülen E.granulosus'un neden olduğu zoonotik bir enfeksiyondur. Hastalık Türkiye'de özellikle Doğu ve Güney Doğu Bölgeleri ile İç Anadolu'da sıklıkla rastlanmaktadır. Kistik ekinokokkozis tanısında ultrasonografi, bilgisayarlı tomografi gibi radyolojik görüntüleme yöntemleri oldukça başarılıdır. Hastalığın tanısı esas olarak serolojik yöntemlerle doğrulanan bu görüntüleme tekniklerine dayanır. Bu tez çalışmasında klinik şüphe nedeniyle radyolojik değerlendirme yapılan hastalarda, üç farklı serolojik yöntemin karşılaştırılması amaçlanmıştır. Çalışmada Necmettin Erbakan Üniversitesi Tıp Fakültesi Tıbbi Mikrobiyoloji laboratuvarına kistik ekinokokkozis şüphesi ile gönderilen hastalara ait veriler otomasyon sistemi üzerinden taranmış ve ultrasonografi, bilgisayarlı tomografi ve/veya manyetik rezonans görüntüleme gibi radyolojik görüntüleme yöntemlerinden en az biri istenmiş olanlar çalışmaya dahil edilmiştir. Toplam 80 hastanın serum örnekleri İndirekt Hemaglütinasyon (İHA), Enzyme-Linked Immunsorbent Assay (ELISA) ve immünokromotografik yöntem ile incelenmiş ve kistik ekinokokkozis tanısında üç farklı serolojik yöntem sonuçları ile radyolojik görüntüleme sonuçları karşılaştırılmıştır. Çalışmaya dahil edilen 80 hastada radyolojik görüntüleme yöntemleri ile %77,5 oranında pozitiflik, ELISA ile %80 oranında pozitiflik, IHA ile %58,8 oranında pozitiflik, immünokromotografik yöntem ile %37,5 oranında pozitiflik bulunmuştur. Hasta örneklerinden 30'u her üç serolojik yöntemle de pozitif olarak bulunurken, 16 hasta her üç serolojik yöntemle de negatif olarak saptanmıştır. Kullanılan tanı yöntemleri arasındaki uyum istatistiksel olarak Cohen kappa sonuçları ile değerlendirilmiştir. Radyolojik değerlendirme ile en yüksek düzeyde uyum ELISA testinde bulunmuş ve 'önemli düzeyde uyum' olarak raporlanmıştır. IHA ve radyolojik değerlendirme arasındaki uyum 'orta düzeyde uyum' iken immünokromotografik yöntem ile radyoloji arasındaki uyum 'zayıf düzeyde uyum' olarak bulunmuştur. Serolojik tanı yöntemleri kendi içinde değerlendirildiğinde, IHA ve ELISA 'orta düzeyde uyumlu' olarak hesaplanmıştır. Radyolojik değerlendirme referans yöntem olarak alındığında; serolojik yöntemlerden duyarlılığı en yüksek olan yöntem ELISA (%93,6), özgüllüğü en yüksek olan yöntem IHA ve immünokromatografik test (%72,2), pozitif ve negatif prediktif değeri en yüksek olan (sırasıyla %90,6 ve %75) yöntem ise ELISA olarak bulunmuştur. Çalışma sonuçlarında radyoloji ile en yüksek uyum gösteren serolojik yöntem, ELISA yöntemi olarak bulunmuştur. Kistik ekinokokkozis tanısında radyolojik bulguların, özellikle klinik şüphenin yüksek olduğu hastalarda en az iki serolojik yöntemle doğrulanmasının uygun olacağı sonucuna varılmıştır.
Cystic echinococcosis is a zoonotic infection caused by E. granulosus, which is seen in countries where agriculture and animal husbandry are common. The disease is frequently encountered in Turkey, especially in the Eastern and Southeastern Regions and Central Anatolia. Radiological imaging methods such as ultrasonography and computed tomography are very successful in the diagnosis of cystic echinococcosis. The diagnosis of the disease is mainly based on these imaging techniques, which are confirmed by serological methods. In this thesis study, it was aimed to compare three different serological methods in patients who underwent radiological evaluation due to clinical suspicion. In the study, the data of the patients sent to Necmettin Erbakan University Faculty of Medicine Medical Microbiology laboratory with the suspicion of cystic echinococcosis were scanned through the automation system and those who were requested at least one of the radiological imaging methods such as simultaneous ultrasonography, computed tomography and/or magnetic resonance imaging were included in the study. Serum samples from a total of 80 patients were taken and examined by Indirect Hemagglutination Test (IHA), Enzyme-Linked Immunsorbent Assay (ELISA) and immunochromatographic methods, and the results of three different serological methods in the diagnosis of cystic echinococcosis and radiological imaging results were compared. In 80 patients included in the study, 77,5% positivity was found with radiological imaging methods, 80% positivity with ELISA, 58,8% positivity with IHA, 37,5% positivity with immunochromatographic method. While 30 of the patient samples were found positive by all three serological methods, 16 patients were found to be negative by all three serological methods. The consistency between the diagnostic methods used was statistically evaluated with the Cohen's kappa results. The highest level of agreement with the radiological assessment was found in the ELISA test and reported as 'significant agreement'. While the agreement between IHA and radiological evaluation was 'moderate agreement', the agreement between the immunochromatographic method and radiology was found to be 'poor agreement'. When we evaluated the serological diagnosis methods within themselves, IHA and ELISA were calculated as 'moderately compatible'. When radiological evaluation is taken as the reference method, the method with the highest sensitivity among serological methods is ELISA (93,6%), the method with the highest specificity is IHA and immunochromatographic test (72,2%). The ELISA method had the highest positive and negative predictive value (90,6% and 75%, respectively). In the results of the study, the serological method with the highest agreement with radiology was found to be the ELISA method. It was concluded that it would be appropriate to confirm the radiological findings with at least two serological methods in the diagnosis of cystic echinococcosis, especially in patients with high clinical suspicion.
Cystic echinococcosis is a zoonotic infection caused by E. granulosus, which is seen in countries where agriculture and animal husbandry are common. The disease is frequently encountered in Turkey, especially in the Eastern and Southeastern Regions and Central Anatolia. Radiological imaging methods such as ultrasonography and computed tomography are very successful in the diagnosis of cystic echinococcosis. The diagnosis of the disease is mainly based on these imaging techniques, which are confirmed by serological methods. In this thesis study, it was aimed to compare three different serological methods in patients who underwent radiological evaluation due to clinical suspicion. In the study, the data of the patients sent to Necmettin Erbakan University Faculty of Medicine Medical Microbiology laboratory with the suspicion of cystic echinococcosis were scanned through the automation system and those who were requested at least one of the radiological imaging methods such as simultaneous ultrasonography, computed tomography and/or magnetic resonance imaging were included in the study. Serum samples from a total of 80 patients were taken and examined by Indirect Hemagglutination Test (IHA), Enzyme-Linked Immunsorbent Assay (ELISA) and immunochromatographic methods, and the results of three different serological methods in the diagnosis of cystic echinococcosis and radiological imaging results were compared. In 80 patients included in the study, 77,5% positivity was found with radiological imaging methods, 80% positivity with ELISA, 58,8% positivity with IHA, 37,5% positivity with immunochromatographic method. While 30 of the patient samples were found positive by all three serological methods, 16 patients were found to be negative by all three serological methods. The consistency between the diagnostic methods used was statistically evaluated with the Cohen's kappa results. The highest level of agreement with the radiological assessment was found in the ELISA test and reported as 'significant agreement'. While the agreement between IHA and radiological evaluation was 'moderate agreement', the agreement between the immunochromatographic method and radiology was found to be 'poor agreement'. When we evaluated the serological diagnosis methods within themselves, IHA and ELISA were calculated as 'moderately compatible'. When radiological evaluation is taken as the reference method, the method with the highest sensitivity among serological methods is ELISA (93,6%), the method with the highest specificity is IHA and immunochromatographic test (72,2%). The ELISA method had the highest positive and negative predictive value (90,6% and 75%, respectively). In the results of the study, the serological method with the highest agreement with radiology was found to be the ELISA method. It was concluded that it would be appropriate to confirm the radiological findings with at least two serological methods in the diagnosis of cystic echinococcosis, especially in patients with high clinical suspicion.
Açıklama
Yüksek Lisans Tezi
Anahtar Kelimeler
Kistik Ekinokokkozis, Echinococcus Granulosus, ELISA, IHA, Cystic Echinococcosis, Echinococcus Granulosus
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Turgut, T. (2023). Kistik ekinokokkozisli hastaların serolojik tanısında IHA, ELISA ve immunokromotografik yöntemlerin karşılaştırılması. (Yayımlanmamış yüksek lisans tezi). Necmettin Erbakan Üniversitesi, Sağlık Bilimleri Enstitüsü Tıbbi Mikrobiyoloji Anabilim Dalı, Konya.
