斑点金免疫渗滤试验同步检测抗梅毒螺旋体IgM和IgG抗体的研究

Detection of serum antibodies in patients with syphilis by DIGFA

目的探求一种可用于梅毒诊断及疗效考核的简便、快速、可靠的方法。方法建立检测抗梅毒螺旋体抗体的斑点金免疫渗滤试验(DIGFA),平行检测梅毒患者血清中IgM和IgG抗体,对患者在治疗前和治疗后血清中特异抗体水平的动态变化进行研究;以梅毒螺旋体血凝试验(TPHA)法为金标准,对临床上疑为梅毒患者的360份血清进行TPHA法和DIGFA法检测对比。结果用DIGFA法对已确诊为Ⅰ期、Ⅱ期和Ⅲ期梅毒患者治疗前血清中特异IgM抗体的检出率分别为82.61% (38/46)、100.00%(24/24)和77.78%(14/18);IgG抗体的检出率分别为60.87%(28/46)、91.67%(22/24)和88.89%(16/18);在Ⅰ期梅毒患者血清中特异IgM抗体的阳性率高于IgG抗体(P<0.05),在Ⅱ期和Ⅲ期梅毒患者血清中,两类抗体的阳性率均较高,且差异无统计学意义(P均>0.05)。58例两类抗体均阳性的梅毒患者经有效药物治疗后3个月、6个月、1年、1.5年、2年连续采血,经DIGFA检测连续观察的结果表明,IgM抗体出现较早,阴转较为明显和迅速,治疗后3个月的阴转率就达31.03%(18/ 58),1年的阴转率可达93.10%(54/58);而IgG抗体出现较晚,阴转缓慢,治疗后1年的阴转率仅为34.48%(20/54)。结论DIGFA是检测抗梅毒螺旋体抗体的有效方法,早期梅毒的诊断和疗效考核可检测IgM抗体,而IgG抗体的检测则主要用于回忆性诊断,不适用于判断是否治愈或再感染。

Objective To explore a simple, fast and reliable assay for diagnosis and efficacy assessment of syphilis. Methods Dot immunogold fihration assay（DIGFA） was used to test the change of specific antibodies in sera from syphilis patients before and after treatment with effective drugs. With the Treponema pallidum hemagglufination assay（TPHA） as the golden standard, 360 sera taken from suspicious syphilis patients were examined by DIGFA and TPHA. Results The positive rate of specific IgM in sera taken from primary syphilis, secondary syphilis and tertiary syphilis patients before treatment were 82.61% （ 38/46 ）, 100.00% （24/24） and 77.78 % （ 14/ 18）, respectively. The positive rate of specific IgG in these sera were 60.87 % （28146）, 91.67 % （22/24） and 88.89% （16/18）, respectively. IgM appeared earlier than antibody IgG, and disappeared quickly after treatment, reaching 31.03% （18/58） and 93.10% （54/58） 3 months and 1 year after treatment, respectively. However, the disappearance rate of antibody IgG only reached 34.48%（20/58） 1 year after treatment. Conclusion DIGFA is an effective method to test the specific antibodies of IgM and IgG in syphilis patients. The detection of IgM can be used for the diagnosis and efficacy assessment of primary and secondary syphilis, while the detection of IgG can be mainly used in retrospective diagnosis for syphilis and is not fit for the efficacy assessment and the judgement of syphilis reinfection.