免疫组化检测二期梅毒皮损梅毒螺旋体

Detection of Treponema pallidum by immunohistochemistry in secondary syphilitic lesions

目的探讨免疫组化法（IHC）对二期梅毒皮损中梅毒螺旋体（TP）的定性和定位诊断的价值。方法采用特异性兔抗人TP多克隆抗体标记的IHC和W—S镀银染色法分别检测25例二期梅毒皮损及对照组15例非TP感染性皮损中的TP。结果IHC和W—S法检测二期梅毒皮损中TP的阳性率分别是80．00％和44．00％，差异具有统计学意义（Fisher’s Exact Test，P=0．046）。IHC检测阳性的20例均可在表皮内查见TP，11例可在真皮中查到TP。TP数量与皮损类型有关，扁平湿疣〉丘疹〉斑丘疹〉斑疹（妒=15．694，P=0．011）。对照组皮损中均未检出TP。结论IHC对二期梅毒皮损中TP的检测优于传统W—S镀银染色法，对二期梅毒的诊断具有重要价值，其对TP的准确定位还有助于梅毒皮损形成的研究。

Objective To evaluate the diagnostic value of immunohistochemistry （IHC） for the identification and localization of Treponema pallidum （TP） in secondary syphilitic lesions. Methods Skin tissue specimens were obtained from the lesions of 25 patients with secondary syphilis and 15 patients with dermatoses unrelated to TP infection, followed by fixation and embeding. IHC using a polyclonal antibody against TP and Warthin-Starry （W-S） silver stain were carried out respectively to detect TP in these specimens. Results TP was detected in 80.00% （20/25） of the specimens by IHC, 44.00% by W-S silver stain （Fisher＇s Exact Test, P = 0.046）. Of the 20 IHC-based TP-positive specimens, all harbored TP in the epidermis, 11 also in the dermis. The density of TP was associated with the types of skin lesions, and sequentially decreased from condyloma latum to papules, maculopapules and maculae （X^2 = 15.694, P = 0.011 ）. Spirochetes were not seen in any of the control lesional specimens. Conclusions IHC is superior to traditional W-S silver stain for detecting spirochetes in secondary syphilitic lesions, and is of great value to the diagnosis of secondary syphilis. The accurate localization of TP by IHC may facilitate the study on the formation of syphilitic lesions.