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SAF 고정변에서 Giarder lamblia 의 cyst검출을 위한 검사방법의 평가

Other Titles
 Evaluation of Giardia lamblia detection method in stool specimens fixed with SAF solution 
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Giardia lamblia는 범세계적으로 분포하는 병원성을 가진 장내 원충류로 이질아메바 다

음으로 빈도가 높은 데도 (金등, 1971) Giardia lamblia 자체의 빈도를 조사하기 위한 시

도는 거의 없었고 단지 이질아메바를 검사하는 과정에서 부수적으로 감염빈도가 조사되었


Giardia lamblia의 진단은 대변검사가 통상 이용되고 있으나 감사방법, 재료의 보관, c

yst배출의 불규칙성, 검사자의 정밀도와 검사기간 및 횟수에 따라 양성률에 많은 차이를

보이고 있으며 효과적인 검출방법이 미흡한 실정이다.

본 연구는 Giardia lamblia연구의 기초적 사료로서 분변내 cyst의 검출방법을 재평가하

여 최소한 시행하여야 할 채변간격 및 횟수를 검토하고 실험을 시행하였다.

전북지방 모보육원 소아 75명을 대상으로 매일, 격일, 2일간격으로 10회씩 분변을 채취

하여 SAF용액에 고정한 뒤 거즈로 걸러 원침시킨 다음 침사를 3등분하여 직접도말법, for

malin-ether 침전법(MGL)및 황산아연 (ZnSO^^4 )부유법에 적용하여 다음과 같은 결과를


연령 및 성별에 따른 감염률은 대상집단의 Giaraia lamblia 양성률은 60 %였으며, 4세

이하 연령군에서 그 이상의 군에 비해 높은 양성률을 보였으며, 남녀별로는 차이가 없었


각 검사법에 따른 양성률은 직접도말법과 MGL법이 비슷하였으며, ZnSO^^4 부유법에 비

해 유의하게 높았다. 세가지 검사법중 하나만 사용한 경우보다 두가지 방법을 같이 사용

했을 때 양성률이 높았으나 세가지 중 어느 두가지를 선택해도 검사법간의 유의한 차이는


검사횟수에 따른 양성률은 직접도말법이나 MGL법으로 3회이상에서 80%이상의 검출률을

얻을 수 있었고 5회이상에서 92%이상의 검출률을 얻을 수 있었다.

채변간격에 따른 검출률의 유의한 차이는 관찰되지 않았다.

이상의 결과로 보아 Giardia labblia증 진단을 위한 분변검사는 직접도말법과 MGL법이

효과적이며, 두가지 이상의 방법으로 3회이상 채변하여 검사하면 실제 감염률에 가까운

검출률을 얻을 수 있을 것으로 생각된다.


Giardia lamblia, a protozoan parasite of man, is ubiquitous. At one time it was

widely believed that Entameba histolytica was the only pathogenic protozoan

parasite of the gut but it is now generally acknowledged that Giardia lamblia is

the pathogenic parasite of the upper digestive tract. There have been noticeably

few attempts to assess the prevalence of Giardia lamblia itself and the only survey

reports likely to contain accurate prevalence data for Giardia would be those

conducted to detect E.histolytica(Healy, 1979)

Although diagnosis of G. lamblia infection is still largely dependent upon stool

examination, different results have been resorted due to a number of factors: 1)

differences in stool examination techniques utilized, 2) the use of preservatives

in specimens, 3) the inherent variability with which G. lamblia is excreted, and 4)

the number of stool examined.

The present study has been designed as a basic study on laboratory diagnosis of

Giardiasis and to demonstrate a more effective method for the detection of G.

lamblia cyst with the inherent advantages of minimizing both the number of stool

examinations required and the interval of stool collections for estimating the real

state of prevalence in the shortest time possible.

There were 3 subject groups of 75 children each currently residing in an orphange

in Gunsan city, Jeonbuk province from which stool spedimens were collected every

day, every other day, and every 3 days. The procedure is as follows: 1) resuspend

the fixed sample after fixation with SAP solution 2) centrifuge the sediment for 1

min. at 2,000 rpm. after straining through gauze into a tube 3) divide the sediment

into 3 parts and use them for Direct fecal smear, Formalin-ether concentration(MGL)

and Zinc sulfate (ZnSO^^4 ) floatation techniques.

The results are summarized as follows :

1) Overall infection rate after 10 trials showed a 60% positive indication.

The positive rate among children under 4 years old was significantly higher than

the rate in children over 4 years old. No significant difference in rate by sex was


2) The results of the examinations by direct fecal smear and MGL techniques

revealed them to be more accurate than the ZnSO^^4 floatation method as indicated

by a higher positive rate. Of all three methods considered, combinations of any two

demonstrated a higher positive rate than that shown by any one alone.

3) In three consecutive examinations under varying conditions such as different

days, the cyst detection rate by MGL technique indicated 83%.

In 5 examinations under the same varying conditions, the indicated rate was 94%.

4) The interval of stool collection proved to be insignificant in the cyst

detection rate.

In conclusion, both the MGL method and the modified fecal direct smear can

provide a good cyst detection rate of Giardia lamblia provided that more than 3

consecutive examinations of stool under varying conditions are carried out.
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