92169例拟受血患者梅毒螺旋体特异性抗体检测与分析  

Detection and Analysis of Antibodies Against Treponema Pallidum in 92169 Cases of Blood Recipients

作　　者：曹微微[1] 李宁[1] 梅城 李碧娟[1] 肖超奇[1] 陈廷寅[2] CAO Wei-wei;LI Ning;MEI Chen(Depar tment of Blood Transfus ion of Xiangya Hospital,Central South Univer s ity,Changsha,410008)

机构地区：[1]中南大学湘雅医院输血科,长沙410008 [2]中南大学湘雅医院信息科,长沙410008

出　　处：《临床输血与检验》2018年第5期493-495,513,共4页Journal of Clinical Transfusion and Laboratory Medicine

摘　　要：目的评估化学发光微粒法(CMIA)检测梅毒螺旋体抗体的特异性,并分析不同年龄段及性别之间梅毒螺旋体阳性率的差异。方法采用CMIA法对本院住院和门诊92169例拟受血患者的血清标本进行梅毒螺旋体特异性抗体(抗-TP)检测,阳性标本用梅毒螺旋体明胶颗粒凝集试验(TPPA)确认。结果 CMIA法检测发现阳性2 825例,TPPA法阳性确认2680例,CMIA筛查结果与TPPA法确认结果比较,假阳性率0.16%,阳性预测值94.87%。CMIA法S/CO值越大,经TPPA法TP阳性确认率越高;S/CO值小于2的阳性标本确认率仅为72.8%,低于其他S/CO值组;S/CO值大于5的标本,TPPA法阳性确认率为100.0%;比较各S/CO值组TPPA法获得阳性率的差异有统计学意义(χ~2=138.26,P <0.001)。拟受血患者中TP感染率为2.91%;感染率随年龄的增长而增高(χ~2=353.69,P <0.001),60岁以上老年人感染率高于其他人群(χ~2=206.97,P <0.001)。男性感染率为2.78%,女性为3.04%,不同性别患者病毒感染率的差异有统计学意义(χ~2=4.86,P=0.027)。结论CMIA在抗-TP检测中的灵敏度较好,适合大批量筛查。对于CMIA法检测梅毒特异性抗体阳性的标本,尤其是S/CO低值样本(S/CO为1～2),有必要进行TPPA复检,以提高检测结果的准确性,避免临床医疗纠纷。住院和门诊拟受血患者中抗-TP阳性率随年龄增长而增高,同时老年人的假阳性率也较高,因此对老年人的梅毒试验阳性结果应慎重对待。Objective To evaluate the specificity of antibodies（anti-TP） to Treponema pallidum detected by chemiluminescent microparticle immunoassay（CMIA）,and to analyze TP infection in the patients before blood transfusion. Methods CMIA was used to detect the anti-TP in 92 169 cases of pre-transfusion patients. The sera with initially positive anti-TP was then confirmed by T.Pallidum particle agglutination（TPPA）. Results 2 825 serum samples were antiTP positive by CMIA. Among them,2 680 were confirmed to be positive by TPPA assay. Compared with the TPPA assay,the false positive rate of the CMIA was 0.16%,and the positive predictive value was 94.87%. In the samples with S/CO value between 1 and 2,the seroprevalence of anti-TP was 72.8%,while in the samples with S/CO value more than 5,the seroprevalence of anti-TP was 100% when tested with TPPA,showing a significant difference among all S/CO value groups（χ~2=138.26,P〈0.001）. The positive rate of anti-TP antibodies increased with age（χ~2=353.69,P〈0.001）,and wassignificantly higher in elderly people over 60 years（χ~2=206.97,P〈0.001）. The TP infection rate in females is much higher than that in males（χ~2=4.8 6,P =0.027）. Conclusions A part of blood recipients before transfusion have TP infection.CMIA shows high sensitivity and useful for mass screening in detection of anti-TP,but low S/CO value indicates relatively high false positive TP infection. Finding anti-TP positive samples with TPPA is necessary,especially in low S/CO value. The positive rate of anti-TP increased with age,and the false positive rate was higher in the elderly,indicating that the positive results of syphilis test in this population should be cautiously treated.

关 键 词：梅毒螺旋体特异性抗体 化学发光微粒子免疫分析法 梅毒螺旋体明胶颗粒凝集试验 

分 类 号：R377.1[医药卫生—病原生物学] R446.11[医药卫生—基础医学]