血清及脑脊液TP-ELISA、TPPA、RPR检测在神经梅毒的诊断价值及相关性  

The value of TP-ELISA,TPPA and RPR detection in serum and cerebrospinal fluid for the diagnosis of neurosyphilis

作　　者：李宇[1] 娄金丽[1] 冯霞[1] 刘意[1] 魏虹娟[1] 唐冬松 

机构地区：[1]首都医科大学附属北京佑安医院临床检验中心,100069

出　　处：《北京医学》2015年第12期1149-1151,共3页Beijing Medical Journal

摘　　要：目的探讨脑脊液梅毒螺旋体抗体酶联免疫吸附试验（TP-ELISA）、梅毒螺旋体明胶凝集试验（TPPA）、快速血浆反应素试验（RPR）对神经梅毒的诊断价值及其与血清检测的相关性。方法将北京佑安医院2015年1-10月收治的100例疑似神经梅毒的患者按照神经梅毒的诊断标准分为神经梅毒组（38例）及非神经梅毒组（62例）,均采集脑脊液、血清进行梅毒荧光密螺旋体抗体吸收试验（FTA-ABS）、TP-ELISA、TPPA、RPR检测,比较TP-ELISA、TPPA、RPR 3种方法的敏感性、特异性、阳性预测值及阴性预测值,并进行血清与脑脊液标本的相关性分析。结果脑脊液TP-ELISA、TPPA、RPR 3种方法检测神经梅毒的敏感性分别为94.7%、100.0%、55.3%,特异性分别为71.0%、85.5%、100.0%,阳性预测值分别为66.7%、80.9%、100.0%,阴性预测值分别为95.7%、100.0%、78.5%。ROC曲线分析,TPPA的AUC=0.989,P〈0.000 1;TP-ELISA的AUC=0.961,P〈0.000 1。神经梅毒组与非神经梅毒组血清TP-ELISA的S/CO值分别为28.01±1.46和23.74±1.37,TPPA中位数分别为1：640、1：320,RPR中位数分别为1：64、1：16,差异均有统计学意义（P〈0.05）。血清和脑脊液TP-ELISA标本的相关系数r=0.4,P=0.000;TPPA的相关系数r=0.3,P=0.001;RPR的相关系数r=0.4,P=0.000。结论脑脊液TPPA检测具有较高的敏感性和阴性预测值,脑脊液TP-ELI-SA存在一定假阳性,应联合RPR作为筛查试验,TPPA作为确证试验。脑脊液梅毒3种检查方法与血清检测结果相关。Objective To evaluate the value of the three detection methods（TP-ELISA, TPPA and RPR） in cerebrospinal fluid（CSF） for the diagnosis of neurosyphilis. Methods One hundred cases of suspected neurosyphilis in Beijing You＇an Hospital during January to October 2015 were recruited and divided into neurosyphilis group（38 cases） and nonneurosyphilis group（62 cases）. The serum and CSF specimens were detected by FTA-ABS, TP-ELISA, TPPA and RPR respectively. The sensitivity, specificity, positive predictive value and negative predictive value were counted. ROC was used to evaluate the diagnostic value of TPPA and TP-ELISA in CSF. Results The sensitivity of TP-ELISA、TPPA and RPR was 94.7%, 100.0%, 55.3% respectively. The specificity was 71.0%, 85.5%, 100.0% respectively. The positive predictive value was 66.7%, 80.9%, 100.0%, and the negative predictive value was 95.7%, 100.0%, 78.5% respectively. The AUC was 0.989（P〈 0.000 1） in TPPA. S/CO was 28.01±1.46,23.74±1.37; The titer of TPPA was 1：640, 1：320; The titer of RPR was 1：64,1：16 respectively in neurosyphilis group and non- neurosyphilis group（P all0.05）. The AUC was 0.961（P〈 0.000 1） by TP-ELISA. The correlation analysis in serum and CSF specimen showed that r = 0.4, P = 0.000 by TPELISA, r = 0.3, P = 0.001 by TPPA, and r = 0.4, P = 0.000 by RPR. Conclusion Both the sensitivity and the specificity of TPPA is high for the detection of neurosyphilis. TP-ELISA and RPR can be used for preliminary screening test, TPPA can be used to confirm the diagnosis.There is a correlation between CSF and serum detection in neurosyphilis.

关 键 词：神经梅毒 梅毒螺旋体 脑脊液 梅毒螺旋体抗体酶联免疫吸附试验 梅毒螺旋体明胶凝集试验 快速血浆反应素试验 

分 类 号：R759.1[医药卫生—皮肤病学与性病学] R446.6[医药卫生—临床医学]