不同方法对进展期梅毒诊疗价值的对比分析  

Comparative analysis of different methods for the diagnosis and treatment of advanced syphilis

作　　者：张艳梅[1] 李长彬 郭玮[3] ZHANG Yanmei;LI Changbin;GUO Wei(Department of Clinical Laboratory,Yulin Second Hospital,Yulin 719000,Shaanxi,China;Department of Clinical Laboratory,Hanzhong Maternal and Child Health Care Hospital,Hanzhong 723000,Shaanxi,China;Department of Dermatology,Yulin First Hospital,Yulin 719000,Shaanxi,China)

机构地区：[1]榆林市第二医院检验科,陕西榆林719000 [2]汉中市妇幼保健所检验科,陕西汉中723000 [3]榆林市第一医院皮肤科,陕西榆林719000

出　　处：《中国性科学》2018年第3期68-72,共5页Chinese Journal of Human Sexuality

基　　金：陕西省自然科学基金(140291)

摘　　要：目的:比较不同检测方法对进展期梅毒诊断和治疗的临床价值,为进展期梅毒诊断方法及治疗效果跟踪提供参考。方法:选择2015年1月至2016年1月我院收治的疑似进展期梅毒患者118例作为研究对象,所有患者均根据临床表现及暗视野检查结果进行梅毒感染诊断。根据诊断结果,将患者分为进展期梅毒患者组(62例)和非进展期梅毒患者组(56例)。所有患者均取静脉血分离血清进行梅毒螺旋体抗原血清实验(甲苯胺红不加热试验(TRUST)、荧光密螺旋抗体试验(FTA-ABS)、快速血浆反应素环状卡片试验(RPR)、梅毒螺旋体化学发光免疫法(TP-CLIA),比较两组患者上述指标的差异,进展期梅毒患者治疗前后的差异,以暗视野检查阳性及临床表现(皮疹、扁平湿疣、黏膜损伤等)为诊断进展期梅毒的金标准,上述四指标单独与联合诊断进展期梅毒的灵敏度、特异度。结果:进展期梅毒患者TRUST滴度、FTA-ABS滴度、RPR滴度、S/CO值均明显高于对照组(P<0.05)。进展期梅毒患者完成治疗疗程后TRUST滴度、RPR滴度较治疗前明显降低(P<0.05),FTA-ABS-IgM水平、S/CO值有所降低,但治疗前后比较差异无统计学意义(P>0.05)。TRUST、TP-CLIA、FTA-ABS、RPR试验及相应的组合诊断进展期梅毒的灵敏度比较差异无统计学意义,但TRUST、TP-CLIA诊断进展期梅毒的特异度均明显高于FTA-ABS、RPR试验,TRUST+TP-CLIA+FTAABS诊断的灵敏度和特异度均明显高于单一指标和其它组合指标。结论:非特异性螺旋体血清抗原试验和特异性梅毒血清抗原试验相结合对进展期梅毒患者的诊断和治疗疗效观察具有较高的临床意义。Objectives:To compare the clinical value of different detection methods in the diagnosis and treatment of advanced syphilis,and to provide reference for its diagnosis and treatment.Methods:118 patients with suspected progressive syphilis in our hospital from January 2015 to January 2016 were selected as the research objects.All patients were diagnosed by the clinical manifestations and the results of dark field examination.According to the results of diagnosis,the patients were divided into 2 groups,progressive syphilis group(n=20)and non-progressive syphilis group(n=56).All the patients were taken venous blood serum for toluidine red unheated test(TRUST),fluorescent treponemal antibody test(FTA-ABS),rapid plasma reagin test(RPR)and treponema pallidum chemiluminescence immunoassay(TP-CLIA).The differences between the two groups in the above indicators was compared.The difference between before and after treatment in progressive syphilis group was compared.With positive dark field examination and clinical manifestation(rash,flat condyloma,mucosal injury)as the gold standard of diagnosis of syphilis,the diagnostic sensitivity and specificity was compared between separation and combination of the four indicators above.Results:The TRUST,FTA-ABS-IgM,RPR and S/CO of patients with progressive syphilis were significantly higher than those in the control group(P<0.05).The TRUST titer and titer of RPR was significantly lower than that before treatment in the progressive syphilis group(P<0.05),and FTA-ABS-IgM level,S/CO value decreased,but without significant difference between before and after treatment(P>0.05).The sensitivity of TRUST,TP-CLIA,FTA-ABS and RPR was not significant from the corresponding combination for diagnosis of syphilis,but the specificity of TRUST and TP-CLIA in diagnosis of syphilis were significantly higher than that of FTA-ABS,RPR test,while the sensitivity and specificity of TRUST+TP-CLIA+FTA-ABS were significantly higher than the single index and other index combination.Conclusion:The combination o

关 键 词：进展期梅毒 非特异性螺旋体抗原血清试验 梅毒螺旋体血清抗原试验 诊断 治疗 临床价值 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]