几种实验室检测方法在神经梅毒诊断中的比较

Comparisons of several laboratory tests in the diagnosis of neurosyphilis

目的 探讨性病研究实验室试验（VDRL）与几种检测方法在神经梅毒诊断中的敏感性和特异性差异.方法 取未经治疗或经治疗梅毒血清固定的隐性梅毒患者脑脊液（CSF）,进行VDRL、RPR、TPPA、荧光梅毒螺旋体抗体吸收试验（FTA-ABS）、CSF常规和生化等检查.比较VDRL与这几种试验的敏感性、特异性、阳性预测值、阴性预测值的差异.结果 在总共61例符合隐性梅毒诊断的病例中,CSFRPR的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）分别为93.44%（57/61）、99.32%（293/295）、96.61%（57/59）、98.65%（293/297）,CSF-TPPA分别为91.80%（56/61）、82.71%（244/295）、52.34%（56/107）、97.99（244/249）,CSF-FTA-ABS分别为93.44%（57/61）、82.71%（244/295）、52.78%（57/108）、98.39%（244/248）,蛋白定量分别为49.18%（30/61）、97.29%（287/295）、78.95%（30/38）、90.25%（287/318）.结论 目前CSF-RPR、CSF-TPPA、CSF-FTA-ABS、蛋白定量等均不能替代CSF-VDRL作为NS诊断试验.CSF-RPR有较高的敏感性和特异性,其诊断效用指标ROC（receiver operating characteristic）曲线下面积（area under curve,AUC）与CSF-TPPA、CSF-FTA-ABS以及蛋白定量有统计学差异.

Objective To compare the sensitivity and specificity of venereal disease research laboratory （VDRL） test versus several other laboratory tests in the diagnosis of neurosyphilis. Methods Lumber puncture was conducted to obtain cerebrospinal fluid （CSF） from untreated outpatients with latent syphilis （LS） or serofast outpatients with LS. Then, VDRL test, rapid plasma regain （RPR） test, Treponema pallidum particle agglutination （TPPA） assay, fluorescent treponemal antibody-absorption （FTA-ABS） test and protein quantification were performed on these CSF samples. The sensitivity, specificity, positive predictive value and negative predictive value were compared between VDRL test and four other laboratory tests in the diagnosis of neurosyphilis. Results Totally, 61 cases of latent syphilis were included in this study. The sensitivity, specificity,positive predictive value and negative predictive value were 93.44% （57/61）, 99.32%（293/295）, 96.61%（57/59）, 98.65% （293/297）for CSF-RPR, respectively, 91.80% （56/61）, 82.71% （244/295）, 52.34% （56/107）,97.99 （244/249） for CSF-TPPA, respectively, 93.44% （57/61）, 82.71% （244/295）, 52.78%（57/108）, 98.39%（244/248） for CSF-FTA-ABS, respectively, and 49.18%（30/61）, 97.29% （287/295）, 78.95% （30/38）,90.25% （287/318） for CSF protein quantification, respectively. Conclusions CSF-VDRL cannot be replaced by CSF-RPR, -TPPA, -FTA-ABS, or CSF protein quantification in the diagnosis of neurosyphilis. CSF-RPR shows a high sensitivity and specificity in the diagnosis of neurosyphilis, with an increased diagnostic capability （area under the receiver operating characteristic curve） compared with CSF-TPPA, CSF-FTA-ABS or CSF protein quantification.