广州市梅毒网络直报病例实验室诊断依据核查结果分析

Analysis of Laboratory Diagnosis Results for Syphilis Reported Directly by Networkin Guangzhou

目的核查并分析梅毒报告病例的实验室检查结果,为客观分析广州市梅毒疫情并制定下一步的梅毒防治措施提供依据。方法设制统一的核查表,从大疫情网下载广州市2012年报告的梅毒病例,根据历年梅毒流行特征,按隐性∶一期∶二期∶其他=5∶2∶2∶1的比例抽样,通过现场调查进行核查,资料统一录入数据库,用SPSS19.0软件分析。结果共核查2 402例梅毒,报告率为31.47%,其中RPR和TPPA双阳性者占58.49%,TPPA单阳性者占8.12%,RPR单阳性者占16.28%,仅TP-ELISA等筛查单阳性者占4.58%,4.50%病例为临床报告。在RPR和TPPA双阳性的报告病例中,未行RPR定量检测的占12.95%;已检测的RPR滴度中,二期梅毒RPR≥1:16者占61.07%,而隐性梅毒和胎传梅毒RPR≤1∶8者分别占82.21%和78.79%。结论广州市网络直报梅毒存在不合理诊断和报告,要加强梅毒网络疫情报告质量管理,加强临床医生对梅毒诊断,尤其是实验室检查项目规范利用的培训,提高梅毒报告质量。

Objective To investigate the accurate rate of syphilis reported directly by network, the laboratory test re suits of syphilis were reviewed and analyzed in Guangzhou. Methods Datum of syphilis reported from Guan gzhou in 2012 were downloaded from unified case reporting system of China CDC and sampled according to the proportion of 5 ： 2： 2： 1 for latent syphilis, primary syphilis, secondary syphilis and the others respectively. The cases were reviewed through field investigation. All of datum was input to the database for SPSS19.0 a nalysis. Results A total of 2402 syphilis cases were reviewed. It was shown that accuracy rate of syphilis re porting was 31.47% in whole. 58.49% cases were both RPR and TPPA positive, of this number, there were 12.95% without RPR quantitative test. 8.12% cases were only TPPA positive, and 16.28% were only RPR positive, 4.58% were only TPELISA positive. In addition, 4.50% case was without any laboratory test re suits. RPR riter of 61.07% of secondary syphilis was more than 1 ： 16 （ including 1 ： 16 ）, and that of 82. 21% of latent syphilis and of 78.79% of congenital syphilis was lower than 1 ： 8 （ including 1 ： 8 ）. Con clusion Syphilis cases reported directly by network existed excessive diagnose and reporting. It was sugges ted that management of syphilis reporting and training of syphilis diagnosis knowledge, especially the use of laboratory tests, should be strengthened to improve the quality of syphilis reporting.