摘要
目的通过对梅毒患者的血清及脑脊液样本的灵敏度特异性的检测,评价三种方法学对于梅毒以及神经梅毒的诊断价值。方法对483例患者采用TRUST(甲苯胺红不加热试验实验),TPPA(梅毒明胶颗粒凝集试验),FTA-ABS(荧光梅毒螺旋体检测)3种方法学进行梅毒血清及脑脊液检测,梅毒血清学阳性的患者进行常规驱梅治疗,半年后复查并评价三种方法学单独及联合检测的灵敏度及特异性。结果 483例患者中梅毒血清阳性患者为372例,血清TRUST检测梅毒的灵敏度和特异性分别为68.64%、88.34%,TPPA检测梅毒的灵敏度和特异性分别为100%,99%。血清FTA-ABS检测梅毒的灵敏度和特异性均为100%。血清联合检测的灵敏度和特异性均为100%。脑脊液TRUST检测神经梅毒的灵敏度和特异性分别为88.64%、98.13%,脑脊液TPPA检测神经梅毒的灵敏度和特异性分别为100%和99%,FTA-ABS检测神经梅毒的灵敏度和特异性分别为96.4%和100%,脑脊液联合检测的灵敏度和特异性均为100%。治疗半年后52例复查脑脊液TRUST TPPA及FTA-ABS,TRUST转阴率为40.38%(21/52),滴度下降率71.15%(37/52),滴度<1:4,TPPA及FTA-ABS均阳性,血清TRUST转阴率为7.69%(4/52),滴度下降率51.92%(27/52),滴度<1:16,脑脊液TRUST转阴率较血液TRUST转阴率高,差异有统计学意义(P<0.05)。结论脑脊液TRUST可作为其疗效观察,判愈,复发或再感染的指标。荧光梅毒螺旋体检测方法学做为确诊实验有一定优势,但在脑脊液检测方面阳性率略低于TPPA,应联合TPPA作为神经梅毒的确诊病例标准,实验室对于脑脊液梅毒的筛查诊断还应该以TPPA为主,联合TRUST作为疗效观察,联合FTA-ABS作为梅毒确诊实验。
Objective To study the syphilis patients serum and cerebrospinal fluid for the sensitivity/specificity and correlations in detection methodology, so to evaluate three kinds of methodologies for syphilis especially the diagnostic value of neurosyphilis. Methods In 483 cases,TRUST(toluidine red unheated test),TPPA( syphilis gelatin particle agglutination test),and FTA-ABS treponema pallidum(fluorescence detection) used to test syphilis serum and cerebrospinal fluid. Patients with syphilis serology positive were given the regular flooding treatment. After six months, we reviewed and evaluated three methodologies separately and the joint detection for the sensitivity and specificity. Results Among 483 patients, there were 372 cases of patients with positive serum for syphilis. For TRUST to detect syphilis serum, the sensitivity and specificity were 68. 64% and88.34% respectively,TPPA syphilis detection of 100% and 99%.,and FTA-ABS detection of 100%. For serum levels of joint detection, the sensitivity and specificity were 100%. There were 52 patients with cerebrospinal fluid positive diagnosis of neurosyphilis. For neurosyphilis cerebrospinal fluid,TRUST had the sensitivity and specificity of 88.64% and 98.13% respectively,TPPA of 100% and 99% respectively,and FTA-ABS of 96. 4% and 100% respectively. The cerebrospinal fluid joint detection had the sensitivity and specificity of 100%. After six months,in 52 cases of cerebrospinal fluid,TRUST TPPA and FTA ABS were used for reviewing. TRUST overcast rate was 40.38%(21/52),and degree of decline rate was 71. 15%(37/52),and drops of <1:4,TPPA and FTA-ABS were positive,and serum TRUST overcast rate was 7.69%(4/52),drops fell rate was 51.92%(27/52),drop degree < 1 : 16. Cerebrospinal fluid TRUST overcast rate was relatively higher than blood TRUST turns shade rate,(P < 0.05). Conclusion CSF TRUST can be used as for curative effect observation, also the index of relapse or reinfection. Fluorescence treponema pallidum test methodology,as the confirmed experiment,has certain advantages,but the positive rate is slightly lower than the TPPA in cerebrospinal fluid examination. It should be jointly used with TPPA as neurosyphilis standard of for confirming cases. The laboratory cerebrospinal fluid syphilis screening diagnosis should give the priority to TPPA,joint TRUST as a clinical observation,and joint FTA-ABS as syphilis diagnosis experiment.
作者
徐飞
刘颖
周淳
王雅杰
XU Fei;LIU Ying;ZHOU Chun;Wang Ya-Jie(Beijing Ditan Hospital Capital Medical University ,Beijing100015,China)
出处
《标记免疫分析与临床》
CAS
2018年第11期1736-1739,共4页
Labeled Immunoassays and Clinical Medicine
基金
首都医科大学附属北京地坛医院院内科研基金"育苗计划"项目(编号:DTYM201803)
关键词
神经梅毒
荧光螺旋体吸附试验
梅毒明胶颗粒凝集试验
甲苯胺红不加热试验实验
Neurosyphilis
Fluorescent treponemal antibody absorption test
Syphilis gelatin particle agglutination test
Toluidine red unheated test Experiment
作者简介
通讯作者:王雅杰
