三种梅毒血清学试验方法的比较分析

Comparison and Analysis of Three Serological Testing Methods in Detection of Syphilis

目的探讨引起梅毒特异性抗体检测的假阳性结果可能的原因。为临床治疗梅毒提供更有价值的试验依据。方法收集我院2005年1月-2008年4月9 456例门诊病人的血清标本,采用TRUST法测定梅毒血清非特异性脂类抗原。TPPA法和ELISA法测定血清梅毒螺旋体特异性抗体。结果受检的9 456人次中经TPPA确证的梅毒540例,检出率5.71%。540例确诊的梅毒中TRUST法318例阳性,敏感性58.9%。42例经TPPA法确证为阴性,特异性88.3%。ELISA法538例阳性,敏感性99.6%。3例经TPPA确诊为阴性,特异性99.4%。TPPA法检出梅毒的阳性率与ELISA法差异无显著性(χ2=0.2,P>0.05),但明显高于TRUST法(χ2=222,P<0.05),差异性显著。结论TRUST法和ELISA法联合检测结合病史,体检结果及其他检测结果综合分析后作出诊断,才能避免造成误诊。

Objective To investigate the possible cause of false positive result of syphilis specific antibody detection, and to provide valuable experimental evidence for the clinical treatment of syphilis. Methods Serum samples of 9,456 outpatients from January, 200.5 to April, 2008 in our hospital were collected to detect the non- specific lipid antigen of syphilis using TRUST. TPPA and ELISA were used to detect Treponema pallidum （Tp） specific antibody. Results Of 9,456 examined subjects, 540 were confirmed to be infected syphilis by TPPA, with the detection rate of 5.71%. 318 cases were posi- tive by TRUST in 540 patients with definite diagnosis of syphilis, with the sensitivity of 58.9 %. 42 cases were negative by the TPPA, with the specificity of 88.3%. 538 cases were positive by ELISA, with the sensitivity of 99.6%. 3 cases were negative by TPPA, with the specificity of 99.4 %. The positive rate of detection of syphilis was not significant between TPPA and ELISA （X^2 = 0.2, P〉0.05）, but that of TPPA was significantly higher than that of TRUST （X^2 = 222, P〈 0.05）. Conclusions TRUST and ELISA methods combined with medical history and health check - up results are recommended to be used as an effective approach to improve the accuracy of syphilis diagnosis.