梅毒螺旋体血清学调查结果分析

Serological survey of status of Treponema pallidum infection in Nanshan District of Shenzhen

目的了解本地区梅毒感染的流行病学情况,并对TRUST、TP-ELISA和TPPA三种检测梅毒螺旋体的方法进行临床应用评价,为预防和控制梅毒蔓延提供科学依据。方法对2006年1月～2008年12月前来本院就诊的5000份患者血清标本进行TRUST、TP-ELISA或TPPA梅毒螺旋体血清学检测,并结合流行病学史及临床表现,进行梅毒流行病学调查。随机抽取上述梅毒阳性患者血清样本120份与健康体检者血清样品130份,对每份标本同时进行TRUST、TP-ELISA和TPPA检测,评价其敏感性和特异性。结果2006～2008年度梅毒阳性率分别为2.9%,4.3%和7.7%;一期梅毒分别为57.9%、71.9%和62.3%,二期梅毒分别为32.6%、23.4%和30.3%,三期梅毒分别为1.8%、1.5%和2.0%,隐性梅毒分别为7.7%、3.2%和5.4%;梅毒患者中女性多于男性,男女比例为0.68:1,年龄分布主要在青壮年,文化程度主要以低素质为主,职业分布以服务业和打工者为主。TRUST、TP-ELISA和TPPA的敏感性分别为73.6%、89.5%和63.5%,特异性分别为89.4%、96.0%和100%。结论梅毒感染呈逐年上升趋势,防治措施亟待进一步加强。3种方法中TP-ELISA法敏感性最高,TPPA特异性最高。ELISA方法存在假阳性和假阴性结果,对于ELISA阳性的标本和在灰区的标本应做TPPA进行确认。而TRUST主要在判断患者病情和疗效方面有重要价值。

Objective To investigate the epidemical features of Treponema pallidum infection in outpatients and evaluate the results of TRUST,TP-ELISA and TPPA for detecting antibodies to Treponema pallidum. Methods The 5000 serum specimens were collected from outpatietns during Jan 2006 to Dee 2008. TRUST,TP-ELISA and TPPA were employed to detect syphilis antibodies. The fetures of Treponema pallidum infection were surveyed. Results The positive rate of syphilis was 2.9% ,4.3% and 7.7% from 2006 to 2008 respectively. The positive rate of primary stage syphilis was 57.9%, 71.9%,62.3% ,the positive rate of second stage syphilis was 32.6% ,23.4% ,30.3% and the positive rate of third syphilis was 1.8%, 1.5 % and 2.0% and the positive rate of latent syphilis was 7.7%, 3.52% and 5.4% from 2006 to 2008 respectively. The sensitivity of TRUST,ELISA and TPPA were 73.6% ,89.5% and 63.5% ,and theirs specificity were 89.4% ,96.0% and 100%. Significant differences in education background, sex, age distribution and occupation were observed. Conclusion The infection rate o syphilis is increasing and effective measures be taken to control syphilis. The positive samples by ELISA be confirmed by TPPA and TRUST is valuable in assessment of degree of disease and therapeutic effect.