130例梅毒筛查检测弱反应性结果分析  

Analysis of Results of 130 Cases of Weak Reactivity in Syphilis Screening

作　　者：王欣俞 丁晓娜 赵晋文 崔凯 潘杰 王鑫琪 张延海 高德禄 郭奕阳[3] 马海娜 WANG Xinyu;DING Xiaona;ZHAO Jinwen;CUI Kai;PAN Jie;WANG Xinqi;ZHANG Yanhai;GAO Delu;GUO Yiyang;MA Haina(Department of Clinical Laboratory,Hebei Yanda Hospital,Langfang 065201,China;Hebei Yanda Medical Research Institute,Langfang 065201,China;Department of Clinical Laboratory,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北燕达医院检验科,河北廊坊065201 [2]河北燕达医学研究院,河北廊坊065201 [3]河北医科大学第四医院检验科,石家庄050011

出　　处：《医学综述》2019年第23期4742-4746,共5页Medical Recapitulate

基　　金：河北省卫生青年科技课题(20180899)

摘　　要：目的探讨梅毒实验室检测弱反应性结果,分析梅毒免疫印迹检测在临床诊断中的应用价值。方法选取2018年1月至2019年6月河北燕达医院梅毒雅培i2000化学发光法检测S/CO值1~9弱反应性的130例样本进行临床方法学诊断。选用梅毒螺旋体颗粒凝集试验(TPPA)和西门子XP化学发光免疫分析(CLIA)进行复核,以梅毒螺旋体免疫印迹试验(TP-WB)检测方法为确证实验。结果130例化学发光微粒子免疫分析法(CMIA)初筛梅毒检测的S/CO值为1~9弱反应性样本,以CLIA复核,92例阳性,38例阴性,与CMIA相比,灵敏度为0.586,特异度为1.000,差异有统计学意义(P<0.001);以TPPA复核,98例阳性,32例阴性,与CMIA相比,灵敏度为0.570,特异度为1.000,差异有统计学意义(P<0.001);TPPA复核结果和CLIA方法相比,灵敏度为0.516,特异度为0.543,差异无统计学意义(P>0.05);以TP-WB平行检测作为确证方法,40例反应性结果,其中8例阳性,32例可疑阳性,90例阴性,与CMIA相比,灵敏度为0.942,特异度为1.000,差异有统计学意义(P<0.001)。TP-WB反应性结果显示阳性判读,抗体表达为2个条带并着色强度低;可疑阳性判读,抗体表达单一着色强度明显降低。结论当梅毒检测结果为弱反应性时,应结合患者生理情况或基础疾病等因素进行综合分析,不能将CMIA、CILA、TPPA检测作为临床梅毒诊断依据,避免漏诊和误诊;以免疫印迹检测作为梅毒临床诊断试验,检测结果可疑阳性多见,故梅毒实验室临床确证在临床诊断中对于弱反应人群尤为重要。Objective To explore the results of weak reactivity test in syphilis laboratory and analyze the application of syphilis immunoblotting in the clinical diagnosis.Methods A total of 130 samples of S/CO 1-9 weak reactivity detected by Abbott i2000 from Jan.2018 to Jun.2019 in Hebei Yanda Hospital were selected for clinical methodological diagnosis.Treponema pallidum particle agglutination assay(TPPA)and Siemens XP chemiluminescent immunoassay(CLIA)were used for check.The results were confirmed by Treponema pallidum Western blot(TP-WB)assay.Results The initial screening of syphilis by chemiluminescent particle immunoassay(CMIA)S/CO value,there were 130 cases of 1-9 weakly reactive samples.When CLIA was used for checking,92 cases were positive and 38 cases were negative:compared with CMIA,the sensitivity was 0.586,the specificity was 1.000,and the difference was statistically significant(P<0.001).According to TPPA,98 cases were positive and 32 cases were negative:compared with CMIA,the sensitivity was 0.570,the specificity was 1.000,the difference was statistically significant(P<0.001).Compared with CLIA,the sensitivity and specificity of TPPA were 0.516 and 0.543 respectively,there was no significant difference(P>0.05).Using TP-WB parallel test as confirmatory method,40 cases of reactivity results were confirmed,including 8 positive cases,32 suspicious positive cases,90 negative cases;compared with CMIA,the sensitivity was 0.942,the specificity was 1.000,the difference was statistically significant(P<0.001).TP-WB reactivity interpretation was positive interpretation,antibody expression was 2 bands and staining intensity was low;as for suspicious positive interpretation,it was single antibody expression and the staining decreased significantly.Conclusion When the results of syphilis test are weak reactivity,comprehensive analysis should be carried out according to the physiological condition or basic diseases of patients.CMIA,CILA and TPPA should not be used as the basis of clinical diagnosis,so as to avoid missed dia

关 键 词：梅毒 弱反应性 梅毒免疫印迹检测 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]