評估B、C型肝炎和愛滋病毒篩檢在南台灣法醫解剖實務之生物安全性的應用價值

Evaluation the Value of Biosafety in Forensic Autopsy by HBV/HCV/HIV Screening in Southern Taiwan

10.6134/tjfm.2013.0502.02

楊婉鈴(Wang-Ling Yang)；孫家棟(Chia-Tung Shun)

司法解剖 ； 生物安全 ； B及C型肝炎病毒 ； 愛滋病毒 ； 免疫色層分析試劑 ； Forensic autopsy ； Biosafety ； Hepatitis B and C virus ； Human immunodeficiency virus ； Immunochromatographic test

台灣法醫學誌

5卷2期（2013 / 12 / 01）

9 - 15

繁體中文

法醫病理醫師和法醫從業人員易有得到血行性傳播病毒感染的風險，範疇包括B型肝炎病毒（HBV）、C型肝炎病毒（HCV）和愛滋病毒（HIV）。強調生物安全的最主要目的，是減少或消除有害潛在生物性物質之暴露。快速有效且在現場就可以篩驗的試劑幫助法醫師察覺潛在傳染性疾病之風險。這篇文章的主旨在於評估免疫色層分析試劑的效果，我們以即時定量聚合酶鏈鎖反應（real-time polymerase chain reaction）為確認黃金準則（golden standard），並分析HBV、HCV和HIV血液性傳染疾病在南台灣的盛行率；免疫色層分析試劑的結果與即時定量聚合酶鏈鎖反應結果相比較。結果呈現在南台灣HBV DNA司法解剖中的盛行率為8.4%，HCV RNA盛行率為6%；B型肝炎快篩試劑，其敏感性為42.9%、特異性為97.4%；而C型肝炎快篩試劑的敏感性為80%、特異性為87%。至於愛滋病即時定量聚合酶鏈鎖反應，我們只送驗了部分檢體，因為這些檢體皆未檢出HIV RNA，所以愛滋病毒快篩試劑的效度無法評估。另外以概似比（likelihood ratio），來解釋試劑是否具診斷價值是有用的。B型肝炎快篩試劑的估計得病機率由測試前0.084上升到測試後0.6；C型肝炎快篩試劑的估計得病機率由測試前0.06上升到測試後0.283。為了避免在司法解剖時血行性病毒感染的風險，我們可以應用快篩試劑來建立生物安全性。

Forensic pathologists and forensic associated personnel are at a continuous risk of acquiring blood-borne viral infections, including HBV, HCV and HIV. A fundamental objective of biosafety is to reduce or eliminate exposure of potentially harmful biological agents. The availability of rapid, point-of-care tests may increase the awareness of the potential transmission by increasing opportunities for testing outside of traditional laboratory settings. We regarded realtime polymerase chain reaction as golden standard of confirmation. The aims of this study were to evaluate the performance of the immunochromatographic test (ICT) and to analyze the seroprevalence of HBV, HCV and HIV in Southern Taiwan. Performance of the ICT tests were compared to real-time PCR. As a result, the Southern Taiwan postmortem prevalence of HBV DNA and HCV RNA were 8.4% and 6% respectively. The sensitivity and specificity for the detection of HBsAg were 42.9 and 97.4%. On the other hand, anti-HCV were 80 and 87%. We only analyzed partial samples for HIV RNA. Since HIV RNA was not detectable in these cases, the validation of HIV ICT test can't be calculated from these study. Another set of measures, which are referred to as likelihood ratio (LR) is useful in the interpretation of diagnostic tests. The estimated probability of the presence of HBV has risen from 0.084 to 0.6 and HCV has risen from 0.06 to 0.283. In order to avoid the risk of acquiring blood-borne viral infections during autopsy, we could apply ICT test in establishing biosafety.

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