belirlendi. Sonuç olarak; •
• •
• ELISA testinin VCA IgM test için elde edilen duyarlılık ve özgüllük oranları oldukça yüksek olup Akut infeksiyonu tanımlama performansı yeterli bulunmuştur.
• • •
• ELISA yöntemi ile belirlenen VCA IgG ve EBNA IgG için özgüllük ve duyarlılık oranları açısından bir değerlendirme yapıldığında her iki testin; Seronegatif, Yeni geçirilmiş infeksiyon ve Eski infeksiyon belirleme oranlarında farklılık göze çarpmaktadır. Özellikle ELISA VCA IgG testi IFA referans teste göre yetersiz performans sergilemiş olup bu antikorun infeksiyonun erken safhalarında oluşup ömür boyu pozitif kaldığı düşünüldüğünde diğer antikor parametreleri ile yapılan kombine serolojik yorumlarda belirsizliğe yolaçabilir.
• • •
• ELISA EBNA IgG için elde edilen yetersiz duyarlık oranı ise VCA IgG’nin pozitif olduğu durumlarda VCA IgG aviditesinin belirlenmesiyle aşılabilir.
• • •
• EBV enfeksiyonu tanısında birden fazla parametre ile değerlendirilme gereksinimi olup IFA tanı paneli bir hasta numunesinde 5 paremetrenin (VCA-IgG, VCA-IgG avidite, VCA-IgM, EBNA-IgG ve EA antikor) aynı anda değerlendirilmesi fırsatı tanımaktadır.
39 ELISA için de bütün bu parametrelerin ayrı ayrı çalışılabileceği bilinsede tanı paneli uygulaması değerlendirme pratiği açısından avantajlı gözükmektedir.
• • •
• IFA değerlendirme aşamasında deneyimli personel gereksinimi ve test kitinin 5 parametre fiyat ile alınabilecek olması dezavantaj oluşturmaktadır. ELISA için tek bir parametrenin bağımsız çalışılabilmesi maliyet verimliliğini artırmaktadır ve standart laboratuvar elemanı yeterli olabilmektedir.
• • •
• Bu değerlendirmeler ışığında her iki testin tercih edilebilirliği; testlerin tanı güvenilirliğinin yanı sıra, laboratuvarların teknik ve personel donanımı ve mali olanaklar göz önüne alınarak değişebilir.
40 ÖZET
Amaç: EBV infeksiyonunun serolojik tanısı birden fazla antikor yanıtının değerlendirilip yorumlanmasıyla yapılmaktadır. Bu çalışmada VCA IgM, VCA IgG ve EBNA IgG antikorlarının IFA ve ELISA tanı metodlarıyla çalışılması ve bu metodların tanı değerlerinin karşılaştırılması amaçlandı.
Gereç ve yöntem: Çalışmaya Enfeksiyöz Mononükleoz şüpheli 100 hastanın serum örnekleri dahil edildi. IFA referans metod olarak kabul edildi ve bu doğrultuda örnekler, EBV infeksiyonu tanı standartları göz önüne alınarak; Seronegatif, Akut infeksiyon, Yeni geçirilmiş infeksiyon ve Eski infeksiyon gruplarına ayrıştırıldı. ELISA metodu ile aynı standart kriterler doğrultusunda oluşturulan grupların bu IFA grupları ile uyumu araştırıldı. Ayrıca VCA IgM, VCA IgG ve EBNA IgG antikorları her iki test bazında ayrı ayrı değerlendirilerek ELISA metodu için duyarlılık ve özgüllük oranları belirlendi. IFA metodu ile ayrıca VCA IgG avidite testi çalışıldı ve enfeksiyon dönemleri ile ilişkisi irdelendi.
Bulgular: ELISA metodunun IFA metodu ile uyumu Seronegatiflik, Akut infeksiyon, Yeni geçirilmiş infeksiyon ve Eski infeksiyon için sırasıyla %41, 100, 14,7 ve 74,5 olarak bulundu. Tek bir antikor bazında IFA referans testine göre ELISA metodu değerlendiridiğinde, VCA IgM testinin duyarlılığı %100, özgüllüğü %90,8, VCA IgG’nin duyarlılığı ve özgüllüğü %61,5 ve %53, EBNA IgG’nin ise %78,7 ve %81,1 şeklinde bulundu. IFA metodu ile belirlelnen VCA IgG avitidesinin enfeksiyon ilerlemesiyle genel olarak arttığı gözlemlendi.
Sonuç: Her iki testin; Seronegatif, Yeni geçirilmiş infeksiyon ve Eski infeksiyon belirleme oranlarında farklılık göze çarpmaktadır. ELISA VCA IgG testi IFA referans teste göre yetersiz performans sergilemiştir. Her iki testin tercih edilebilirliği; testlerin tanı güvenilirliğinin yanı sıra, laboratuvarların teknik ve personel donanımı ve mali olanaklar göz önüne alınarak değişebilir.
41 ABSTRACT
Objective: The serologic diagnosis of EBV infection is made by evaluating and interpreting via more than one antibody reply. In this study, it is aimed to be studied of VCA IgM and EBNA IgG antibodies by IFA and ELİSA diagnosis methods and to be evaluated of these methods’ diagnosis values.
Materials and Methods: 100 patients’ serum samples that suspicious of infectious mononucleosis were included to the study. IFA was accepted as the reference method. By this method, considering with diagnosis standards of EBV infections, samples were decomposed to seronegative, acute infection, new afflicted infection and ex-infection groups. The harmony of IFA groups with the groups those were formed by the same criteria with ELİSA method was researched. Also, VCA IgM, VCA IgG and EBNA IgG antibodies were evaluated according to both tests and their sensitivity and specificity rates were determinate for ELİSA method. Also, VCA IgG avidite test was studied by IFA method and the relationship with the infection periods was researched.
Results: The rates of harmony between ELISA method and IFA method for seronegative acute infection, new afflicted infection and ex-infection were found; %41, 100, 14,7, 74,5 respectively. When the ELISA method was evaluated according to IFA reference test in one antibody base, the sensitivity of VCA IgM test was %100, the specificity was %90,8, the sensitivity and specificity of VCA IgG were %61,5 and %53, EBNA IgG’s results were %78,7 and %81,1. The VCA IgG avidite that was determined by IFA method rose generally. Conclusion: There was a difference in determination rates of seronegative, new afflicted infection and ex-infection of both tests. ELISA VCA IgG test had an insufficient performance according to IFA reference test. The performance of both tests can change by some factors such as technique and personnel rigging of the laboratory and financial possibilities.
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48 TEŞEKKÜR
Tıp fakültesinden mezun olarak bayrağını taşıma şerefine nail olduğum bu mukaddes mesleğin en önemli basamağından çıkarken; asistanlığım süresince maddi ve manevi yardımlarını esirgemeyen ve tecrübeleri ile her daim ışık tutan tez hocam Prof.Dr. Mahmut Baykan’a, gerek mesleki gerekse hayata dair pek çok konuda öğrencisi olmaktan kıvanç duyduğum anabilim dalı başkanımız Prof. Dr. Bülent Baysal’a, bilgi ve deneyimleri ile mesleki birikimime değerli katkıları olan Prof. Dr. İnci Tuncer, Prof. Dr. Duygu Fındık’a, başta tez çalışmam olmak üzere hertürlü konuda yardımlarından ve rehberliğinden