梅毒的实验室检查

Laboratory Detections of Syphilis

梅毒是由苍白螺旋体感染引起的一种性传播疾病,临床表现复杂,几乎可侵犯全身各个器官,其诊断依靠流行病学史、临床表现和实验室检查。高灵敏性和高特异性的实验室检查方法,不但对梅毒的诊断具有重要意义,也是判断疗效和复发的重要依据。目前梅毒的实验室检查有:1苍白螺旋体的直接检测,包括暗视野显微镜法(D-F),Fontana镀银染色法、直接免疫荧光检测(DFA)和家兔睾丸感染试验(RIT);2苍白螺旋体的血清学试验,包括非苍白螺旋体试验(VDRL,USR,RPR,TRUST)和苍白螺旋体试验(TPPA,TPHA,FTAABS等);3分子生物学的方法包括常规PCR和荧光定量PCR等,可用于检测各种临床样本中的苍白螺旋体,且可以进行基因分型。三期梅毒、神经梅毒、先天梅毒以及梅毒合并HIV感染等临床情况使实验室诊断变得更为复杂。

Syphilis is a kind of sexually transmitted diseases caused by T. pallidum（ TP） with complicated clinical manifestations. Almost all parts of organs can be involved. The diagnosis depends on epidemiology,clinical manifestations and laboratory detections.Higher sensitive and higher specific laboratory tests are not only significant to diagnose syphilis,but also important to judge curative effect and recurrence. At present,the diagnosis methods for syphilis are broadly divided into the following types： 1direct microsopic examination of the T. pallidum including dark-field microscopy（ DF）,Fontana silver stains,direct fluorescent antibody test（ DFA）,rabbit infectivity test（ RIT）; 2 serological tests including two categories of antibodies-termed non-treponemal,which are directed against phospholipids（ VDRL,USR,RPR,TRUST）,and treponemal,which are directed against T. pallidum polypeptides（ TPPA,TPHA,FTAABS,etc.） have been used for this purpose; 3molecular biological technique including routine PCR and fluorogenic quantitative PCR etc.,which can be used for all kinds of clinical samples and molecular typing. Tertiary syphilis,neurosyphilis,congenital syphilis and syphilis combined with HIV infection make the laboratory diagnosis more complicated.