5种梅毒血清学检测方法的临床适用性分析

The clinical applicability of five syphilis serology detection methods

目的:分析5种不同的梅毒血清学检测方法的敏感性及特异性,筛选高效准确的梅毒检测方法,为临床提供可靠的检测结果。方法:收集我院2011年1月至2013年12月确诊为梅毒阳性患者的386例血清标本,以及264份来自健康者的血清标本,分别采用酶联免疫吸附试验(ELISA)、甲苯胺红不加热血清试验(TRUST)、快速血浆反应素环状卡片试验(RPR)、梅毒螺旋体明胶颗粒凝集试验(TPPA)和梅毒螺旋体血球凝集试验(TPHA)对阳性血清及健康者血清标本进行检测。结果:ELISA和TPPA法的敏感性较高,分别为97.67%和97.41%,两者相比差异无统计学意义(χ2=1.124,P>0.05);ELISA和TPPA法的敏感性均高于TRUST和RPR法(P<0.05);TPHA的敏感性略小于ELISA和TPPA,与两者相比差异无统计学意义(χ2=1.012、0.947,P>0.05);5种血清学检测方法彼此的特异性差异均无统计学意义(P>0.05)。结论:ELISA和TPPA法的敏感性及特异性均较好。在梅毒筛查或临床诊断时,可采用ELISA和TRUST(或RPR法)进行双筛,再经TPPA法确诊。

Objectives： To analyze the sensitivity and specificity of five kinds of different syphilis serology detection methods, to select an efficient and accurate detection method for reliable test results in clinical applica- tion. Methods ： 386 syphilis - positive serum samples from patients diagnosed and 264 serum samples from healthy individuals in our hospital from January 2011 to December 2013, respectively using enzyme - linked immunosorbent assay （ELISA）, toluidine red heating serum test （TRUST）, rapid plasma reagin test （RPR）, reponema pallidum particle agglutination test （TPPA） and Treponema pallidum hemagglutination test （TPHA） for positive serum and healthy serum samples testing. Results： The sensitivity of ELISA and TPPA was higher, 97.67% and 97.41% re- spectively, with no significant difference （X2 = 1. 124, P 〉 0.05 ） ; sensitivity of ELISA and TPPA were higher than TRUST and RPR method （ P 〈 0.05 ） ; the sensitivity of TPHA was slightly less than that of ELISA and TPPA, with no significant difference （X2 = 1. 012,0. 947, P 〉 0.05 ） ; there was no statistically significant difference between each two of the five kinds of serological detection methods （ P 〉 0.05 ）. Conclusion： The sensitivity and specificity of ELISA and TPPA methods are good. For syphilis screening or clinical diagnosis, ELISA and TRUST （ or RPR） can be used for dual screen, before being confirmed by TPPA.