梅毒血清学试验方法诊断评价

Effects of serologic tests on diagnosis of syphilis

目的了解2011年1月-2013年6月临床常用的梅毒血清学试验方法的诊断效果,并对其进行比较评价,以提高检出率。方法采用梅毒甲苯胺红不加热血清试验(TRUST)、苍白密螺旋体酶联免疫吸附试验(TPELISA)和苍白密螺旋体颗粒凝集试验(TPPA)对162例各期梅毒患者(试验组)和非梅毒患者120例(对照组)进行平行检测,比较3种方法敏感性、特异性、阳性预测值和阴性预测值。结果 TRUST对潜伏期梅毒和一期梅毒的阳性检出率低于TP-ELISA和TPPA,差异均有统计学意义(P<0.05),且具有一定的假阳性率;3种方法对二期梅毒和三期梅毒的阳性检出率比较,差异无统计学意义;TP-ELISA和TPPA对各期梅毒的阳性检出率较高;TPPA的敏感性和特异性最好,其次为TP-ELISA,TRUST最差。结论 TRUST对二期和三期梅毒的诊断价值较高,可用于门诊患者筛查和住院患者疗效观察;TP-ELISA成本较低,对各期梅毒的敏感性较高,适于献血人群和高危人群的大批量梅毒筛查;TPPA对各期梅毒诊断的敏感性和特异性均较高,但因成本较高、耗时较长,可用于阳性标本的确证试验。

OBJECTIVE To understand the effects of the commonly used serologic tests on diagnosis of syphilis from Jan 2011 to Jun 2013 and make a comparison so as to raise the detection rate .METHODS A total of 162 patients with various stages of syphilis （ the study group） and 120 non‐syphilis patients （ the control group） were detected by using toluidine red unheated serum test （TRUST ） ,Treponema pallidum enzyme‐linked immunosorbent assay （TP‐ELISA） ,and Treponema pallidum particle agglutination （TPPA） test .The sensitivity ,specificity ,positive predictive value ,and negative predictive value were observed and compared among the three methods .RESULTS The positive rates of detection of latent and primary syphilis were significantly lower by TRUST than by TP‐ELISA and TPPA （P〈0 .05） ,and there was certain false positive rate .There was no significant difference in the positive rate of detection of secondary or tertiary syphilis among the three methods .The positive rates of detection of the various stages of syphilis were relatively high by TP‐ELISA and TPPA .The sensitivity and specificity of the TPPA were the highest ,followed by the TP‐ELISA and the TRUST .CONCLUSION The value of TRUST is high in the diagnosis of secondary and tertiary syphilis ,and it can be used for the screening of outpatients and the observation of efficacy of the hospitalized patients .The cost of TP‐ELISA is low ,and it is sensitive to the various stages of syphilis and is suitable for the screening of syphilis in blood donors and high‐risk populations .The sensi‐tivity and specificity of TPPA are high in diagnosis of various stages of syphilis ,and it can be used for the confirm‐atory test of the positive specimens because of its high cost and long time consuming .