不同梅毒筛查方法效果比较  

Comparison of Accuracy of Different Syphilis Screening Methods

作　　者：张旭东[1] 刘连红[1] 张娟辉[2] 郭小元[3] 郭丽蓉[3] 余立城 谭宏梅[1] 戴小敏[1] 

机构地区：[1]广州医科大学附属武警广东省总队医院检验科,广东广州510507 [2]广东医科大学附属武警广东省总队医院妇产科,广东广州510507 [3]广东医科大学基础学院生物化学教研室,广东广州510006

出　　处：《中国皮肤性病学杂志》2017年第5期569-572,共4页The Chinese Journal of Dermatovenereology

基　　金：广东省自然科学基金项目(2014A030313589;2015A030313843)

摘　　要：目的比较不同梅毒检测方法诊断的准确性,为梅毒筛查和诊断提供依据。方法 23 762例血清标本采用微粒子化学发光免疫分析法(CMIA)和甲苯胺红不加热血清试验(TRUST)联合检测,阳性标本再用梅毒螺旋体明胶颗粒凝集试验(TP-PA)复检,同时对CMIA法检测S/CO值0.50~0.99的阴性血清标本也用TP-PA法复检。CMIA与TP-PA法检测结果不一致的血清标本用免疫印迹法(WB)进行确认。结果 CMIA法联合TRUST法检出1 108例阳性标本(4.66%),其中TRUST法阳性者486例(2.05%),CMIA法阳性者1 074例(4.52%),CMIA法(+)并TRUST法(+)者452例,TP-PA法复检阳性率100%。CMIA法(+)/TRUST法(-)者622例,TP-PA法复检阳性率92.12%;CMIA法(-)/TRUST法(+)者34例,TP-PA法复检阳性率0。CMIA法(-)者的S/CO值0.50~0.99时TP-PA法复检阳性率23.08%,S/CO值1.00~9.99时TP-PA法复检阳性率88.14%,且S/CO值越大,TP-PA法复检阳性率越高,S/CO值≥10.00时TP-PA法复检阳性率100%。WB法对61例CMIA法和TP-PA法不一致标本确证结果显示:CMIA法阳性预测值(PPV)为57.14%,TP-PA法阳性预测值为16.67%,差异有统计学意义(P<0.05)。结论血清梅毒筛查检验方法的敏感性:CMIA法>TP-PA法>TRUST法。CMIA法自动化程度高,结果易保留,为梅毒特异性抗体筛查的首选方法。CMIA法检测阳性的标本需进一步作TRUST及其滴度试验,而CMIA法阴性的标本不必作TRUST试验,以避免TRUST试验假阳性结果误导临床诊疗。CMIA法检测S/CO值处于临界值附近时,临床医生应结合患者临床资料进行综合诊断,对疑似病例进行随访和复检。Objective To compare the accuracy of different laboratory test methods for syphilis in the screening and di- agnosis of syphilis. Methods 2 3762 serum samples were firstly screened using the microparticle chemilu- minescent immunoassay（CMIA） and the toluidine red untreated serum test（TRUST） methods. The positive samples detected with both CMIA and TRUST methods were further tested using treponema pallidumpartivale agglutination assay（TP-PA） method. The negative samples with S/CO ratio of 0. 50 - 0. 99 by CMIA method were also further tested using TP-PA method. The samples with the inconsistent results by CMIA and TP-PA methods were verified by Western blot （WB） method. Results 1 108 samples （4. 66% ） were positive for both CMIA and TRUST; 486 samples （2.05%） were only TRUST positive, and 1 074 samples （4. 52% ） were only CMIA positive. 452 samples with CMIA（ ＋ ）/TRUST（ ＋ ） were also positive for TP-PA. Positive rates for TP-PA were 92. 12% in 622 samples with the CMIA（ ＋ ）/TRUST（ - ）. All 34 samples with theCMIA（ - ）/TRUST（ ＋ ） showed TP-PA negative. 23.08% of samples with S/CO ratio of 0. 504）. 99 and CMIA（ - ） were TP-PA positive while 88. 14% of samples with S/CO ratio of 1.00-9.99 were TP-PA posi- tive. The higher the S/CO ratio, the higher the positive rates for TP-PA were. When S/CO ratio was over 10. 00, positive rates for TP-PA were 100%. In 61 samples with the inconsistent results by CMIA and TP- PA, WB method showed that the positive predictive values（PPV） of the CMIA method were higher than that of TP-PA method （ 57. 14% vs. 16. 67%, P 〈 0. 05 ）. Conclusion The sensitivities of the laboratory screening methods for syphilis arranged in the order from high to low are CMIA, TP-PA and TRUST. CMIA method should be the first choice for screening syphilis because it is highly automatic and the data can be easily stored. CMIA positive, but not negative, samples need to be confirmed by TRUST method in order to avoid false TRUST positive

关 键 词：梅毒 实验室 诊断 化学发光微粒子免疫检测法 甲苯胺红不加热血清试验 梅毒螺旋体明胶颗粒凝集试验 免疫印迹法 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]