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Params: post, 295897, a:51:{i:0;a:4:{s:3:"tag";s:3:"img";s:6:"option";N;s:8:"original";a:2:{i:0;s:5:"[IMG]";i:1;s:6:"[/IMG]";}s:8:"children";a:1:{i:0;s:64:"http://pic3.zhimg.com/v2-4675d0a5a78715d8d5da1b48444793e2_is.jpg";}}i:1;s:8:" 返朴 ";i:2;a:4:{s:3:"tag";s:3:"url";s:6:"option";s:57:"https://www.zhihu.com/question/367822725/answer/985123779";s:8:"original";a:2:{i:0;s:65:"[URL='https://www.zhihu.com/question/367822725/answer/985123779']";i:1;s:6:"[/URL]";}s:8:"children";a:1:{i:0;s:12:"阅读原文";}}i:3;s:1:"
";i:4;a:4:{s:3:"tag";s:6:"indent";s:6:"option";N;s:8:"original";a:2:{i:0;s:8:"[INDENT]";i:1;s:9:"[/INDENT]";}s:8:"children";a:1:{i:0;s:198:"今日新闻“首个新冠病毒检测试剂盒通过检验”。那么病毒检测的原理是什么？来自湖北仙桃的宾西法尼亚大学病理检验系副教授王萍快速撰文讲解。";}}i:5;s:2:"
";i:6;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:15:"撰文 | 王萍";}}i:7;s:6:"
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";i:8;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:51:"现在有哪些检测新型冠状病毒的方法？";}}i:9;s:44:"
检测传染病的策略通常有两种：";i:10;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:24:"检测病原体本身，";}}i:11;s:3:"或";i:12;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:51:"检测人体为了抵抗病原体而产生的抗体";}}i:13;s:33:"。检测病原体既可以检测";i:14;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:69:"抗原（一般是病原体表面蛋白，有些用内部核蛋白）";}}i:15;s:18:"，也可以检测";i:16;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:6:"核酸";}}i:17;s:417:"。如果病人的体液中检测到抗体、抗原或核酸三者中的任何一种，则意味着已被感染。由于抗体产生需要时间，一般几天至几周不等，有些免疫功能较弱的病人可能抗体量很低，容易造成假阴性（已经感染，但是测试结果看起来没有被感染）。而在感染之初，病原体抗原含量也较低，同样不容易检测到。所以，目前";i:18;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:48:"广泛采用的是检测病原体的核酸序列";}}i:19;s:1527:"， 通过扩增反应来放大信号， 检测的灵敏度高、特异性好。
早在 1 月 11 日，新型冠状病毒的全基因序列就已发布（由上海市公共卫生临床中心和公共卫生学院、华中科技大学武汉中心医院、武汉市疾控中心、中国疾控中心传染病预防控制所联合澳大利亚悉尼大学联合完成），国内和国际多个厂家和机构都迅速跟进，开发检测试剂盒。检测试剂盒可以一次性检测几百个样本，而在开发出检测试剂盒之前，一般只能通过 RNA 测序方法检测病毒，速度会很慢。
新型冠状病毒和 SARS 病毒的高度同源性对试剂盒设计也有帮助。由于新型冠状病毒是 RNA 病毒，试剂盒检测基本都采用反转录加实时聚合酶链式反应法（RT-PCR），扩增病原体的核酸 (RNA) ，同时通过荧光探针实时检测扩增产物。这种方法很灵敏，也能够很好地定量。世界卫生组织（WHO）网站上列有德国、香港、泰国、日本和中国疾控中心所使用的检测方法和引物序列，基本都是针对病毒序列中高度保守的 2 至 3 个序列——比如编码 replicase（复制酶）或者 necleocapsid（核蛋白衣，核鞘）的核酸序列——来进行检测。但是各个方法用的序列都不完全相同。一些方法使用 multiplex，也就是把多个目标序列在同一反应管中扩增；另一些采用分步，先用一个目标序列筛查，阳性后再用另一个序列确认。";i:20;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:72:"检测反应的准确程度取决于公布的基因序列的准确程度";}}i:21;s:491:"，以及引物、探针等的设计。从目前公布的有限数据来看，这些试剂盒的准确率都不错。由于现在能检测的病人都是临床高度疑似，所以阳性预测值非常高。
也正是因为这个新型冠状病毒和 SARS 的相似性很高，如果感染的是 SARS 病毒，结果也会是阳性的。
当然，也可用测序方法更准确的确认新型冠状病毒， 但是对仪器要求高，速度也慢一些，不适合大批量筛查。
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";i:22;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:74:"为什么要 multiplex 多重反应？为什么要用多个目标序列？";}}i:23;s:323:"
作为筛查手段，要求是快速和高灵敏度。每个 RT-PCR 反应需要 2 小时左右出结果，multiplex 也就是多个检测平行同步进行，可以有效缩短整个流程时间，加快检测速度。另外病毒变异很快，用多个保守目标序列可以防止病毒变异产生假阴性。
3
";i:24;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:39:"采样以后，多久能拿到结果？";}}i:25;s:329:"
如果就近在同一个医院可以马上检测的话，2-3 小时就应该可以看到结果，但是当地如果感染控制或仪器人员条件不够 （见下个问题），就需要把样本送到区域甚至全国检测中心（比如疾控中心），加上运输时间，可能需要上 24 小时甚至几天。
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";i:26;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:75:"使用检测试剂盒有什么要求？为什么不是每个医院都做？";}}i:27;s:110:"
对新型冠状病毒这样的疾病来说，检测所用的血液或其他体液可能具有高传染性，";i:28;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:66:"检测和离心过程中产生的气溶胶可能感染检测人员";}}i:29;s:667:"，所以对检测实验室在感染控制方面有很高要求。SARS 病毒要求三级生物安全水平（BSL level 3），埃博拉病毒（Ebola）要求四级生物安全水平（ BSL level 4），必须考虑通风、气压、样本流向（指样本从病房通过什么途径到检验实验室，从哪个门进入，到达实验台后从哪个仪器到哪个仪器，废弃样本怎么处理，从哪个门出实验室等系列流程）等方面（见图 2），检测人员也要经过特殊训练。从仪器上来说，至少要有离心机、核酸提取仪器、实时聚合酶链式反应仪器等。所以不是每家医院都有条件做检测。
";i:30;a:4:{s:3:"tag";s:3:"img";s:6:"option";N;s:8:"original";a:2:{i:0;s:5:"[IMG]";i:1;s:6:"[/IMG]";}s:8:"children";a:1:{i:0;s:66:"http://pic1.zhimg.com/70/v2-00374a709d8947f9a1d19d31bc3b9a98_b.jpg";}}i:31;s:2:"
";i:32;a:4:{s:3:"tag";s:3:"img";s:6:"option";N;s:8:"original";a:2:{i:0;s:5:"[IMG]";i:1;s:6:"[/IMG]";}s:8:"children";a:1:{i:0;s:66:"http://pic4.zhimg.com/70/v2-817ceb27ac3a67e9c019d6fc2f4d4473_b.jpg";}}i:33;s:85:"
图：微生物危险度等级相对应的典型保护装备。（来源：CDC）
";i:34;a:4:{s:3:"tag";s:3:"img";s:6:"option";N;s:8:"original";a:2:{i:0;s:5:"[IMG]";i:1;s:6:"[/IMG]";}s:8:"children";a:1:{i:0;s:66:"http://pic2.zhimg.com/70/v2-bf596d89fc2d9898af75069f8c9a690d_b.jpg";}}i:35;s:22:"
来源：wikipedia
";i:36;a:4:{s:3:"tag";s:3:"img";s:6:"option";N;s:8:"original";a:2:{i:0;s:5:"[IMG]";i:1;s:6:"[/IMG]";}s:8:"children";a:1:{i:0;s:66:"http://pic2.zhimg.com/70/v2-3640945bb6ecc634da7718164ff187b5_b.jpg";}}i:37;s:6:"
5
";i:38;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:45:"试剂盒短缺，来不及检测怎么办？";}}i:39;s:172:"
试剂盒短缺影响确诊人数的统计，但对临床治疗影响不大， 因为迄今还没有针对新型冠状病毒的特效药， 临床上根据病人表现，";i:40;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:86:"CT（计算机断层成像）看到肺部典型病变，就可以隔离并开始治疗";}}i:41;s:537:"，治疗也以提供病人生命支持为主，没有必要等待检测结果确诊。如前所述，在疾病高度疑似人群中用一个性能不错的检测试剂去测，由于患病率 （disease prevalence）高，测出的阳性结果有很大可能是真阳性 （positive predictive value 阳性预测值高）， 而反之测出的如果是阴性结果，是真阴性的可能性不大 （negative predictive value 阴性预测值低），所以试剂盒检测结果基本是起确认临床诊断的作用。
作者简介
";i:42;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:6:"王萍";}}i:43;s:48:"，湖北仙桃人，现于宾西法尼亚大学";i:44;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:15:"病理检验系";}}i:45;s:87:"任教，任宾西法尼亚大学医院临床化学及中心实验室主任，致力于";i:46;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:18:"临床疾病检测";}}i:47;s:33:"，研发和产业转化最新的";i:48;a:4:{s:3:"tag";s:1:"b";s:6:"option";N;s:8:"original";a:2:{i:0;s:3:"[B]";i:1;s:4:"[/B]";}s:8:"children";a:1:{i:0;s:24:"疾病诊断预后方法";}}i:49;s:5:"。
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