본 연구는 개에서 심장사상충을 검출하기 위하여 표준검사를 적용하지 않은 상황에서 중합연쇄반응검사 (PCR)의 진단 능력을 평가하였다. 효소면역검사법 (ELISA)과 PCR 검사를 동시에 사용한 경우 PCR 검사의 민감도와 특이도는 두 검사의 조건부 독립을 가정한 상태에서expectation-maximization (EM) 알고리즘을 이용한 최대우도법과 Bayesian 기법으로 두 집단 검사 모형으로 분석하였다 2002-2004년 기간 중 심장사상충검사 결과를 기록한 의무기록에서 무작위로 266개 결과를 추출하여 133개씩 2회의 시험으로 배치하였다. 2회의 분석결과를 종합할 때 EM 알고리즘에서 PCR 검사의 민감도와 특이도는 각각 96.4-96.7%와 97.6-98.8%, Bayesian기법에서는 94.4-94.8h와 97.1-98%로 추정되었다. PCR 검사는 심장사상충을 스크리닝하는 도구로 유용하며, 표준검사를 적용하지 않은 상황에서 진단검사의 특성을 추론하는 방법으로 Bayesian 기법은 매우 유용함을 확인하였다.
Diagnostic performance of polymerase chain reaction (PCR) for detecting Dirofilaria immitis in dogs was evaluated when no gold standard test was employed. An enzyme-linked immunosorbent assay test kit (SnapTM, IDEXX, USA) with unknown parameters was also employed. The sensitivity and specificity of the PCR from two-population model were estimated by using both maximum likelihood using expectation-maximization (EM) algorithm and Bayesian method, assuming conditional independence between the two tests. A total of 266 samples, 133 samples in each trial, were randomly retrieved from the heartworm database records during the year 2002-2004 in a university animal hospital. These data originated from the test results of military dogs which were brought for routine medical check-up or testing for heartworm infection. When combined 2 trials, sensitivity and specificity of the PCR was 96.4-96.7% and 97.6-98.8% in EM and 94.4-94.8% and 97.1-98% in Bayesian. There were no statistical differences between estimates. This finding indicates that the PCR assay could be useful screening tool for detecting heartworm antigen in dogs. This study was provided further evidences that Bayesian approach is an alternative approach to draw better inference about the performance of a new diagnostic test in case when either gold test is not available.
