- 期刊
高雄市國小學童砂眼罹患率的再評估
The Re-Evaluation of the Prevalence of Trachoma in Primary School Children in Kaohsiung City
摘要
為了探討現階段國小學童的砂眼感染情形，我們在高雄市利用隨機取樣選樣對五個國小771位學童作砂眼的臨床檢查及作免疫螢光單株抗體及McCoy細胞培養的檢查。以McCoy細胞培養的結果為判定標準，院受調查的學童有15.3%屬陽性反應。而在有感染的118例中，96.6%的學童結膜呈無或輕微的炎性反應。只有0.4%有結膜瘢痕的併發症。而由資深眼科醫師所做的砂眼判定，以McCoy細胞培養結果為基準，則其敏感度僅50%，而陽性預估值僅26.6%。此顯示單由目視的砂眼檢查相當不準確。結膜抹片的免疫燭光單株抗體檢查有120例(15.6%)為陽性。但與McCoy細胞培養結果作比較，發現其敏感度僅68.4%，單一度為91.7%。此結果顯示若欲以結膜抹片的免疫螢光單株抗體檢查推廣至更大型的流行病學調查來取代臨床及細胞培養，則實驗室的品質有待加強。
關鍵字
無資料並列摘要
For years, trachoma screening has been a routine part of the health examination program for all primary school children. In order to ascertain the current prevalence of trachoma in primary school children, we used clinical examination, immunofluorescein-monoclonal antibody and McCoy cell culture technique to examine 771 children from 5 primary schools in Kaohsiung City. Using the results of the McCoy cell culture as a judgement standard, we found that 118 children (15.3%) had Chlamydia trachomatis infections. The infection rates of children were statistically insignificant for sex, grade and location of school of children. Among the 118 infected children, most had none or mild (96.6%) conjunctival inflammation. Only 3 children (0.4%) had conjunctival cicatrisation complications. These results showed that the repeated reinfectinos among these children were quite few. The McCoy cell culture was used to test the result of clinical diagnosis made by the senior ophthalmologists. The sensitivity of the clinical diagnosis was 50% and the predictive positive rate was 26.6%. It revealed that the diagnosis of trachoma made by clinical observation only was unreliable. The results of immunofluorescein-monoclonal antibody test showed that 120 children (15.6%) had trachomatous infections. Its sensitivity was 68.4%, and specificity was 91.7%. It revealed that more care should be taken in quality control of laboratory techniques. From these results, we conclude: 1) the trachomatous infections of primary school children in Kaohsiung City are not serious; the repeated infections among these children are quite few, and it is not a public health issue. 2) Clinical screening of trachoma by observation only is so unreliable that the item may be excluded from routine health examination in primary school children. 3) If we want to use the immunofluorescein-monoclonal antibody test alone in a massive survey of trachoma, the quality control of laboratory techniques and sampling is important.