三种梅毒血清学检测方法在性病门诊中的应用  

Application of three syphilis serological detection methods in sexually transmitted diseases(STD)outpatient clinics

作　　者：曹伟胜 陈少南 陈伟华 张凤霞 李惠萍 CAO Weisheng;CHEN Shaonan;CHEN Weihua(Clinical Laboratory of Zhaoqing Dermatological Hospital,Guangdong Zhaoqing 526020)

机构地区：[1]肇庆市皮肤病医院检验科,广东肇庆526020

出　　处：《医学检验与临床》2023年第8期12-15,51,共5页Medical Laboratory Science and Clinics

摘　　要：目的:分析化学发光免疫试验(CLIA)、甲苯胺红不加热血清试验(TRUST)及梅毒螺旋体明胶凝集试验(TPPA)在性病门诊梅毒筛查诊断中的临床应用效果,为实验室梅毒筛查和报告流程提供参考依据。方法:回顾性分析2018年1月-2022年3月期间肇庆市皮肤病医院性病门诊,临床疑似梅毒患者初诊时5645例梅毒血清学试验结果和临床资料。血清标本同时运用CLIA、TRUST进行初筛试验,两种方法任一阳性或同时阳性者再行TPPA加以确诊,并对CLIA法S/CO值为0.50-0.99的样本也做TPPA复核,以TPPA作为金标准,分析评价CLIA、TRUST的应用效果。结果:5645例可疑梅毒患者样本,最终经TPPA法确诊为梅毒417例,阳性检出率为7.39%(417/5645),其中CLIA初筛检测出阳性446例,阳性检出率为7.90%(446/5645),TRUST初筛检测出阳性360例,阳性检出率为6.38%(360/5645)。CLIA的敏感度、特异度分别为98.56%、99.33%;TRUST的敏感度、特异度分别为76.50%、99.22%。CLIA的阳性检出率、敏感度均高于TRUST,差异均有统计学意义(X^(2)=9.89,92.97,P均<0.05);TRUST的漏检率高于CLIA,差异有统计学意义(X^(2)=82.14,P<0.05)。97例CLIA法S/CO值为0.50-0.99的样本经TPPA复核检出阳性6例,漏检率为1.44%(6/417)。CLIA法S/CO>15.00时,CLIA与TPPA比较的阳性符合率达到100%(266/266),CLIA法S/CO值为1.00~4.99时的阳性符合率最低,为68.25%(43/63),随着S/CO值的升高,阳性符合率呈上升趋势,不同S/CO区间阳性符合率总体上差异有统计学意义(X^(2)=136.25,P<0.05)。结论:三种方法各有优缺点,在性病门诊高危人群中联合采用CLIA和TRUST进行梅毒筛查,并对初筛阳性及CLIA法S/CO值为0.50~0.99者再作TPPA复核确认,可以形成优势互补、提高梅毒诊断的准确率,有效减少漏检和误诊,是可行的梅毒筛查诊断的策略,值得推广。Objective:To analyze the clinical application effect of chemiluminescence immunoassay(CLIA),toluidine red unheated serum test(TRUST)and Treponema pallidum gelatin agglutination test(TPPA)in screening and diagnosis of syphilis in STD outpatient clinics,to provides a reference basis for laboratory syphilis screening and report Methods:The results and clinical data of 5645 patients with Clinical suspected syphilis who serological test in our hospital were retrospectively analyzed from January 2018 to March 2022.The serum samples were simultaneously screened by CLIA and TRUST.Ofthe Single positive or simultaneous positive samples by CLIA and TRUST and the samples with S/CO value of 0.50-0.99 by CLIA were further tested by TPPA.Analyze and evaluate the application effects of CLIA and TRUST with TPPA As the gold standard.Results:417 cases of 5645 suspected patients were diagnosed as syphilis by TPPA method,and the positive detection rate was 7.39%(417/5645).446 cases were initially detected positive by CLIA,and the positive detection rate was 7.90%(446/5645),360 cases were initially detected positive by TRUST,and the positive detection rate was 6.38%(360/5645).The sensitivity and specificity of CLIA were 98.56%and 99.33%respectively,The sensitivity and specificity of TRUST were 76.50%and 99.22%respectively.The positive detection rate and sensitivity of CLIA were higher than TRUST,and the difference was statistically significant(X^(2)=9.89,92.97,P<0.05);The missed detection rate of TRUST was higher than CLIA,and the difference was statistically significant(X^(2)=82.14,P<0.05).Six positive cases were detected by TPPA in 97 CLIA samples with S/CO value of 0.50~0.99,and the missed detection rate was 1.44%(6/417).When the CLIA value S/CO>15.00,the positive coincidence rate of CLIA compared with TPPA reached 100%(266/266).When the CLIA value S/CO was 1.00-4.99,the positive coincidence rate was the lowest,which was 68.25%(43/63),with the increase of the S/CO value,the positive coincidence rate showed an upward trend,and the o

关 键 词：梅毒螺旋体抗体 梅毒 血清学试验 筛查 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]