梅毒血清学检测作为HIV替代检测指标的应用价值评估  

Evaluation on the value of syphilis serologic test as a surrogate marker for Human immunodeficiency virus infections among blood donors in Dalian Blood Center

作　　者：王旻[1] 邓雪莲[1] 陈辉[1] 王月娟[2] 

机构地区：[1]大连市血液中心,辽宁大连116001 [2]大连医科大学检验学院

出　　处：《中国输血杂志》2015年第2期132-136,共5页Chinese Journal of Blood Transfusion

摘　　要：目的评估梅毒血清学检测在大连血液中心献血者筛查中作为HIV替代检测指标的应用价值。方法统计2008年1月1日-2013年6月30日间大连市血液中心的血液检测数据,按献血者年龄、性别、类别和时间段分别比较不同献血人群的TP和HIV的流行率,估算通过梅毒血清学检测排除的HIV窗口期感染的频率。结果共有321973份血液标本数据纳入统计分析,确认梅毒抗体阳性献血者1393例、确认HIV抗体阳性献血者58例,梅毒与HIV合并感染仅4例。大连地区献血者中梅毒和HIV的流行特征存在明显的年龄、性别、献血者类别及变化趋势的差异。梅毒血清学阳性的血液检出HIV阳性频率显著高于梅毒血清学阴性的血液(P<0.05),但对HIV的检出只有较低的敏感度(7.69%)和阳性预期值(0.21%)。HIVRNA检测的实施进一步降低了梅毒血清学检测对献血者HIV感染检出的敏感度。研究期内,梅毒血清学检测对HIV窗口期的排除率仅为6.5×10-7。结论在本中心现有的HIV抗体和HIVRNA联合检测条件下,梅毒血清学检测作为大连地区献血者HIV替代检测指标的应用价值极小。Objective To evaluate the application of serologic test for syphilis as a surrogate marker for Human immunodeficiency virus（HIV） infections in screening blood donors in Dalian Blood Center.Methods Serologic test results from blood donors in Dalian Blood Center between January 1st,2008 and June 30 th,2013 were analyzed.A comparison was made on the prevalence of syphilis infections in blood donors with the prevalence of HIV infections on the following indicators： age,sex,donor type and time period.The frequency of window- period（W- P） HIV infections predicted by the syphilis serological test was estimated.Results Among 321 973 donations,1 393 syphilis and 58 HIV infections in blood donors were confirmed,while 4 syphilis confirmed cases were also infected with HIV.There were significant differences between epidemiological features of syphilis and HIV infections among Dalian blood donors in their age,sex,types of donors and variation trend.The rate of detecting HIV positive cases in samples tested positive in the syphilis serologic test was observed to have a significantly higher frequency than that in samples tested negative in the syphilis serologic test（P0.05） However,the sensitivity and the positive predictive value of syphilis serologic test positivity in these groups were low at 7.69% and 0.21%,respectively.The application of HIV nucleic acid testing further reduced the sensitivity of syphilis serologic test in excluding HIV infections.In the study period,syphilis serologic test could only remove the window-period（W-P） of HIV infections at a rate of 6.5 × 10- 7.Conclusion Syphilis serologic test serves as a negligible surrogate marker for detecting HIV infections as the nucleic acid testing of HIV applied in Dalian blood donor screening.

关 键 词：梅毒血清学检测 HIV发生率 确证试验 替代指标 

分 类 号：R446.11[医药卫生—诊断学] R512.91[医药卫生—临床医学]