目的 对云南省2015-2016年网报疟疾病例的实验室诊断质量和影响因素进行分析。方法 收集云南省2015-2016年疟疾网报病例,使用显微镜检法和nested-PCR法对样本进行疟原虫诊断核实。计算收样率、符合率、病例就诊所需时间和血片制作评分,利用卡方检验、单因素方差分析对率或均数的差异进行统计分析,分析网报病例质量;利用单因素Logistic回归对影响病例诊断质量的因素进行分析。结果 2015-2016全省疟疾网报病例的收样率为92.15%,收样覆盖全省15个州市。疟疾病例发病到就诊所需要的平均时间为(5.1±6.6)d。全省2015和2016年疟疾网报病例检测与省级疟疾参比诊断实验室镜检和nested-PCR检测阳性的符合率分别为97.1%, 95.1%,95.1%, 95.1%;虫种检测符合率分别为93.1%, 92.3%,91.3%和91.3%。位于边境地区的报告单位诊断水平较高,乡镇卫生院对虫种的诊断结果较为准确,省级疟疾诊断参比实验室较其他报告单位更易检出恶性疟和间日疟的混合感染。全省各级报告单位的血涂片制作平均分为79.18±8.84,且2016年的平均得分高于2015年。单因素Logistic回归结果表明,疟疾病例发病到就诊所需的时间,报告单位的类型及报告单位是否位于边境地区都影响疟疾病例诊断的质量。结论 2015-2016年云南省疟疾网报病例的诊断质量总体较高,各级诊断水平比较稳定。但是,在消除疟疾阶段,应该探讨以防治带动培训,以培训促进提高为目的的多种方式结合的疟疾防治手段,重视持续加强和保持各地各级疾病防治部门对疟疾的综合防治能力。

We analyzed diagnostic quality and impact factors of cases reported through China Information System for Diseases Control and Prevention in Yunnan Province from 2015 to 2016. The blood film and dry blood spot samples from cases reported from 2015 to 2016 were collected. The professionals from Yunnan malaria diagnosis reference laboratory identify malaria and Plasmodium sp. using microscopy and nested-PCR with “double blind”. Samples collected rate, agreement rate of diagnosis of malaria and Plasmodium sp., the time spend by cases from onset of malaria to diagnosis, and score of blood film making were calculated. Chi-square test and one-way ANOVA were employed to infer difference of rate or means. Univariate logistic regression was used to analyze the impact factors of diagnosis. The total samples collected rate was 92.15% in the two years, and the samples collected covered fifteen municipality or autonomous district in the entire province. The average the time spend by cases from onset of malaria to diagnosis was 5.15.1±6.6 days. The agreement rate of malaria diagnosis in 2015 and 2016 was 97.1%, 95.1%, and 95.1%, 95.1% compared to microscopy and nested-PCR in Yunnan reference laboratory of malaria diagnosis, respectively. The agreement rate of Plasmodium sp. in 2015 and 2016 was 93.1%, 92.3%, and 91.3%, 91.3%, respectively. The reporters located in border areas had high quality of malaria diagnosis, and hospital in town level had more accuracy of identification of Plasmodium sp. Moreover, Yunnan malaria diagnosis reference laboratory was better at identification of mixture infection of P. falciparum and P. vivax than remain reporters. The average score of blood film making was 79.18±8.84, and the score of 2016 was higher than 2015. Univariate logistic regression revealed the impact factors of diagnosis quality such as the time spend by cases from onset of malaria to diagnosis, the types of reporters, and whether the location of reporter was in border areas. The total quality of diagnosis of malaria cases reported was high in the entire province from 2015 to 2016, and the diagnostic level of reporters in different levels was stable. However, in the phase of malaria elimination, multiple methods of malaria control and prevention should be deeply study on the basis of developing training by real action of diseases control and improvement by training. Every center of diseases control should focus on enhancing and maintaining the staffs’ comprehensive capacity of malaria control and prevention.