三种方法检测潜伏妊娠梅毒的临床评价

Clinical Evaluation of Three Laboratory Tests for Latent Syphilis in Pregnant Women

目的评价梅毒血清学试验检测潜伏妊娠梅毒的临床价值。方法对1236例围产保健的孕妇血清,用甲苯胺红不加热血清试验(TRUST)检测梅毒反应素,酶联免疫吸附试验(ELISA)、金免疫层析试验(GICA)和梅毒螺旋体颗粒凝集试验(TPPA)检测梅毒螺体抗体,聚合酶反应(PCR)检测梅毒螺旋体DNA。TPPA试验和PCR试验同时阳性判断为潜伏妊娠梅毒。结果 TRUST试验对潜伏妊娠梅毒的诊断灵敏度、诊断特异度、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为75.0%、97.5%、23.1%、99.7%、30.0和0.3,ELISA试验对潜伏妊娠梅毒的诊断灵敏度、诊断特异度、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为91.7%、98.8%、42.3%、99.9%、76.4和0.1,GICA试验对潜伏妊娠梅毒的诊断灵敏度、诊断特异度、阳性预测值、阴性预测值、阳性似然比和阴性似然比分别为83.3%、98.9%、43.5%、99.8%、75.7和0.2。结论临床筛查潜伏妊娠梅毒最好选择ELISA试验,同时联合TRUST、GICA检测梅毒可以提高阳性检测率,为临床预防和阻断梅毒母婴垂直传播提供更可靠的理论依据。

Objective To evaluate the clinical values of three syphilis serologic tests for latent syphilis in pregnant women.Methods Methods The syphilis regain was detected by toluidine red unheated serum test（TRUST）,the trepo-nemal antibody was detected by enzyme linked immunosorbent assay（ELISA）,goldimmunochromatography assay（GI-CA）and treponema pallidum particle agglutination assay（TPPA）,the treponema pallidum DNA was detected by poly-merase chain reaction（PCR）,in the sera from 1236 healthy pregnant women.Latent syphilis in pregnant women were made definite diagnosis with TPPA positive and PCR positive .Results The diagnostic sensitivity（SEN）,diagnostic specificity（SPE）,positive predictive value （PPV）,negative predictive value （NPV）,positive likelihood ratio（PLR）and negative likelihood ratio（NLR）were 75.0%,97.5%,23.1%,99.7%,30.0 and 0.3 by TRUST,respectively.The SEN,SPE,PPV,NPV,PLR and NLR were 91.7%,98.8%,42.3%,99.9%,76.4 and 0.1 by ELISA,respectively.The SEN,SPE,PPV,NPV,PLR and NLR were 83.3%,98.9%,43.5%,99.8%,75.7 and 0.2 by GICA,respectively.Con-clusion The first choice of clinically screening latent syphilis in pregnant women was ELISA.