反向梅毒筛查血清学检测结果分析  

The discordant results in serum through reverse syphilis screening algorithm

作　　者：戴淑琴[1] 王军业[1] 郑炘[1] 吴兴平[1] 苏鸿凯[1] 徐新华[1] 赵擎宇[1] 

机构地区：[1]中山大学肿瘤防治中心华南肿瘤学重点实验室,广州510060

出　　处：《中华流行病学杂志》2013年第10期1006-1009,共4页Chinese Journal of Epidemiology

摘　　要：目的分析以螺旋体抗原血清学试验为初筛的反向梅毒检测方法不一致结果（血清梅毒螺旋体抗体阳性而非梅毒螺旋体抗体阴性）的特点，并据此选择可靠的反向梅毒筛查流程。方法回顾性分析反向梅毒筛查方法的实验室数据，以ELISA作为梅毒螺旋体抗体初筛试验，初筛阳性标本均进行梅毒螺旋体抗体确认（梅毒螺旋体明胶粒子凝集试验，TPPA）和定量非梅毒螺旋体抗体检测（甲苯胺红不加热试验，TRUST），采用X^2检验统计分析实验室数据。结果21049份筛选标本中ELISA初筛阳性666份（3．16％）。其中TRUST阳性169份，经TPPA确认168份阳性，1份阴性，ELISA检测假阳性率为0．6％（1／169）。在666份初筛阳性标本中，TRUST阴性497份，不一致血清结果（ELISA结果阳性，TRUST结果阴性）的比率为74．6％（497／666），497份标本经TPPA确认，有74份为阴性，ELISA检测假阳性率为14．9％（74／497）。经t检验，TPPA阳性组内TRUST阴性和阳性结果构成比的差异有统计学意义（X^2=110．025，P=0．000），即TRUST阴性率（71．6％，423／591）显著高于TRUST阳性率。结论选择ELISA作为梅毒螺旋体抗体初筛方法，应对初筛阳性标本先做TPPA确认，再对确认阳性标本进行定量非螺旋体抗体检测，可避免假阳性结果。Objective The emerging reverse sequence on syphilis screening program generates special discordant results, characterized with the appearance of both positive treponemal test and negative nontreponemal test at the same time. The aim of this study was to analyze the characteristics of the discordant results among low syphilis prevalence population in China, to provide evidence for improving the process of reverse sequence syphilis screening program. Methods Laboratory data was retrospectively analyzed, under reverse sequence screening algorithm selecting ELISA as the initial screening test for syphilis. All the screening reactive samples were tested by TPPA for confirmation and by quantitative TRUST for the reactivity of syphilis. Results 666 out of a total of 21 049 serum samples were reactive under the screening program. Among the 666 reactive samples, 169 were reactive to TRUST. One in the 169 samples was confirmed negative on TPPA, and the faulse positive rate on ELISA was 0.6% （1/169）. In those 666 reactive samples, 497 were nonreactive to TRUST. 74 in the 497 samples were confirmed negative to TPPA, with faulse positive rate of ELISA as 14.9% （74/497）. In the group of 591 TPPA confirmed positive samples, the TRUST negative rate was found 71.6% （423/591）, significantly higher than the TRUST positive rate （chi-square test, X2= 110.025, P=0.000）. Conclusion Among the results from reverse sequence syphilis screening program, majority of the samples which showed positive treponemal antibody, would have negative nontreponemal antibody. We therefore recommended a more reasonable reverse sequence syphilis algorithm to be used. Fanlse positivity could be eliminated if TPPA was performed on all screening reactive samples by ELISA a first and then followed by quantitative TRUST on samples that were TPPA confirmed as positive.

关 键 词：梅毒 反向筛查方法 不一致结果 

分 类 号：R446.6[医药卫生—诊断学]