两种方法联合检测对早期先天性梅毒的监控和诊治价值  

Combination of two detection for monitoring,diagnosis and treatment of early congenital syphilis

作　　者：李明友[1] 黎永新[1] 苏红梅[1] 任勇[1] 林茂锐[1] 陈丹霞[1] 

机构地区：[1]广东省第二人民医院,广州510317

出　　处：《检验医学与临床》2012年第9期1025-1026,1028,共3页Laboratory Medicine and Clinic

摘　　要：目的探讨甲苯胺红不加热血清反应素试验(TRUST)和明胶颗粒凝集试验(TPPA)联合检测对早期先天性梅毒的监控和诊治价值,为临床诊治早期先天性梅毒提供更有价值的实验依据。方法采用TRUST测定梅毒血清非特异类脂质抗原,采用TPPA测定梅毒血清特异性螺旋体抗体。结果 2007～2010年受检的1 846人次中,TPPA确证的梅毒特异性螺旋体抗体阳性94例,检出率为5.09%(94/1 846),而TPPA和TRUST同时阳性仅28例,占总受检人数的1.52%(28/1 846),提示TPPA阳性而TRUST阴性的新生儿仍要定期观察和检查,以便得到及时的诊断和治疗。94例确证的梅毒特异性螺旋体抗体阳性标本中,TRUST阳性28例,敏感性29.79%,TRUST检出33例阳性标本中,5例经TPPA确证为阴性,特异性为84.85%,TPPA检出梅毒的阳性率明显高于TRUST,差异有统计学意义(χ2=52.41,P<0.01)。2007年检出新生儿血清特异性螺旋体抗体阳性20例,2008年29例,较2007年增长40.0%,2009年38例,较2008年增长31.0%。由此提示新生儿先天性梅毒其发病率呈逐年上升趋势,已经成为一个不容忽视的公共卫生问题,应该引起大家重视。结论新生儿胎传梅毒的早期诊断、早期治疗是减少甚至杜绝对患者侵害的最有效方法。母亲在妊娠期内和新生儿出生后在临床监控中同时进行TRUST和TPPA检测,既能提高梅毒血清学的阳性检出率,减少漏检和误判,也可作为观察病程和疗效的指标,以便梅毒患者能得到及时有效的诊治。TRUST和TPPA联合检测为临床诊治早期先天性梅毒提供更有价值的实验室依据,更有利于梅毒的监控和诊治。Objective To explore the diagnostic value of TRUST and TPPA for early congenital syphilis,and provide experimental theory for the clinic.Methods The outcomes of 1 846 sera were detected by TRUST for non specific antigen and TPPA for specific antibody.Results The positive numbers of TPPA reagent for detecting 1 846 sera from 2007 to 2010 were 94,and the positive rates was 5.09%（94/1 846）,while the positive numbers of both TPPA and TRUST were 28,the positive rates was 1.52%（28/1846）,which indicated that the positive of TPPA and the negative of TRUST newborn needed to be observed and checked regularly in order to receive diagnose and treatment in time.The positive numbers of TRUST reagent for detecting 94 sera were 28,the sensitivity rate was 29.79%,and the false positive numbers of TRUST reagent for detecting 33 positive sera were 5,specificity rate was 84.85%.The positive rates for detecting Syphilis of TPPA reagent was higher than that of TRUST reagent,and there were significant difference in the outcomes between TPPA reagent and TRUST reagent（χ2=52.41,P0.01）.The positive number of TPPA reagent detecting was 20 in 2007,and 29 in 2008,and it was increased by 40% than 2007,while 38 in 2009,which was increased by 31.0% than 2008.The incidence of clewing neonatal congenital syphilis was increased,and it became to be a serious public health problem,which that everyone should pay enough attentions.Conclusion Early diagnosis of neonatal preach syphilis is the best way to reduce or even eliminate encroach to patients.It should be monitored and tested during pregnancy and after newborn mothers.TRUST and TPPA not only can improve the positive rate of serologic syphilis,but also reduce targets and misdiagnosed.They can be used as indicate of observation and curative effect,with which patient can get effective diagnosis of syphilis.In combination with TRUST,TPPA test for diagnosing early congenital syphilis provide more valuable experimental theory,which was benefit for detecting and diagnosing of human syphilis

关 键 词：梅毒 先天性梅毒 甲苯胺红不加热血清反应素试验 明胶颗粒凝集试验 联合检测 

分 类 号：R759.152[医药卫生—皮肤病学与性病学]