广州市医疗机构隐性梅毒诊断和报告准确率调查与分析  

Investigation on diagnostic accuracy of latent syphilis directly reported from Guangzhou various medical institutes by network

作　　者：叶兴东[1] 戴向农[1] 刘颖[1] 谢尚仁[1] 何婉苹[1] 汤少开[1] 

机构地区：[1]广州市皮肤病防治所,广州510095

出　　处：《中国艾滋病性病》2014年第2期102-104,共3页Chinese Journal of Aids & STD

基　　金：广东省科技计划项目(编号2012B031800014);广州市医药卫生科技重大项目(编号20121A031001)~~

摘　　要：目的调查广州市医疗机构隐性梅毒的诊断准确率，为进一步采取措施更好地控制梅毒提供依据。方法从传染病直报系统下载广州市医疗机构2012年报告的隐性梅毒病例，分区按不同医疗机构抽取病例，在医疗机构现场核实梅毒血清学检测结果，查阅病历，完成核查登记表。根据隐性梅毒诊断标准，分析各级各类医疗机构及不同科室报告的隐性梅毒的诊断准确率。结果抽查了89家医疗机构报告的1352例隐性梅毒病例，诊断准确率为56．73％。TPPA、TP—ELISA、RPR单阳性报告率分别为16．3％、5．6％、16．3％；TPPA／RPR双阴性报告率5．0％。按疫情报告科室分析，皮肤科报告的准确率高于非皮肤科[Х^2=41．33，P〈0．01，比值比（OR）=3．06，95％可信区间（CI）2．13～4．27]，性病哨点医院报告隐性梅毒的准确率高于非性病哨点（Х^2=25．69，P〈0．01，OR=1．92，95％CI1．50～2．50）；医疗机构皮肤科开展RPR滴度检测多于非皮肤科（Х^2=66．64，P〈0．01，OR=4．27，95％CI2．96～6．16）；性病哨点医疗机构多于非哨点机构（Х^2=39．24，P〈0．01，OR=2．3，95％CI1．71～3．00）；性病专科哨点多于非专科哨点（Х^2=25．24，P〈0．01，OR=8．47，95％CI3．06～23．17）。结论广州市隐性梅毒疫情报告存在过度诊断和报告现象，诊断准确性有待提高。医疗机构需要建立和完善梅毒归口诊疗和会诊制度，同时加强疫情报告人员梅毒知识培训，提高隐性梅毒疫情报告质量。Objective To investigate diagnostic accuracy of latent syphilis and provide a basis for syphilis con- trol in the near future. Methods latent syphilis reported from Guangzhou medical institutions within 2012 were downloaded from unified infectious case reporting network affiliated to Center for Disease Control （CDC） of China, and reviewed by well-trained physicians at various medical institutions where cases were reported. Diagnostic accura- cy of latent syphilis reported by clinicians in various medical institutes and different sections were analyzed by SPSS 13.0 based on diagnostic criteria of latent syphilis. Results One thousand, three hundred and fifty-two cases of la- tent syphilis from 89 medical institutes were reviewed. Overall, latent syphilis diagnostic accuracy （with both TPPA and RPR sero-positive） was 56.73% . The positive rate of TPPA, TP-ELISA and RPR was 16.37%, 5.62% and 16.25 %, respectively. Double negative of TPPA and RPR accounted for 5.03 %. Basing on reports from different sections, accurate rate of latent syphilis reported by dermatologists was higher than that by clinicians from non-der- matology departments with significant difference （Х^2= 41.33, P〈0.01, OR = 3.06, 95 % CI 2.13 - 4.27）, accuracy rate by STD sentinel hospitals was higher than that by non-STD sentinel hospitals with statistical difference （Х^2 25.69, P〈0.01,0R=I. 92, 95%CI 1.50-2.50）. RPR titration test was more frequently used by dermatologists than that by other clinicians （？Х^2=66.64,P〈0.01,OR=4.27, 95%CI 2.96-6.16）, and more frequently used in STD sentinel institutes than that in non-sentinels （Х^2= 39.24,P〈i0. OI,OR=2.3,95%CI 1.71-3.00）. Conclusion Excessive diagnosis and report of latent syphilis were com- monly observed in Guangzhou various medical institutes. Ef fective steps including both intensive training of syphilis di- agnosis knowledge and optimization of case reporting process should be taken to improve quality of latent syphilis cases re porting system.

关 键 词：隐性梅毒 诊断准确率 病例报告 调查 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]