三种梅毒血清学检测方法的临床评价

Clinical Evaluation of Three Kinds of Serological Testing Methods for Syphilis

目的评价三种梅毒血清学检测方法的临床应用价值。方法同时应用梅毒螺旋体明胶颗粒凝集试验（TPPA）、梅毒螺旋体抗体酶联免疫吸附试验（TP—ELISA）、梅毒甲苯胺红不加热血清反应素试验（TRUST）对2561例患者血清标本进行检测（术前患者、输血前患者、产前检查孕妇、性病门诊患者）。用灵敏度、特异性、准确性、阳性预测值、阴性预测值以及Youden指数对三种方法进行评价。以TPPA为对照标准，用χ^2检验分析三种方法对同一标本检验结果的一致性。结果TPPA，ELISA以及TRUST的阳性率分别为20．30％，20．23％和13．71％。以TPPA为标准，ELISA阳性符合率为98．26％（509／518），敏感度、特异性、准确性分别为97．88％，99．56％和99．22％，差异无统计学意义（P〉0．05）；以TPPA为标准，TRUST阳性符合率为99．15％（348／351），灵敏度、特异性、准确性分别为66．92％，99．85％和93．17％，差异也有统计学意义（P〈0．05）。结论三种梅毒血清学检测方法单独使用均不能快速、准确并且经济的检出梅毒抗体，需联合检测以提高梅毒检测的临床符合率。

Objective To evaluate the clinical application of three kinds of serological testing methods for syphilis. Methods There were 2 561 serum samples collected from preoperative patients, patients before transfu- sion,pregnant women with prenatal care as well as outpatients of venereal disease were assayed by TPPA, ELISA and TRUST. The sensitivity, specificity accuracy ,positive predictive value, negative predictive value and Youden index were used to evaluate the three kinds of methods. With TPPA as control standard, Chisquare test was applied to evaluate the consistency of the three detection methods on the same specimen. Results The positive rate of TPPA, ELISA, TRUST were 20. 30% ,20. 23 % and 13.71% respectively. With TPPA as the relative standard method, the positive coincidence rate of ELISA was 98.26% , the sensitivity, specificity and accuracy of ELISA were 97. 88 % ,99.56% and 99.22% respectively. There was no statistical difference between TPPA and ELISA （ P 〉 0. 05 ） ; Similarly, with TPPA as the relative standard method,the positive coincidence rate of TRUST was 99. 15%, the sensitivity, specificity and accuracy of TRUST were 66. 92% ,99. 85% and 93.17% respectively. There was statistically significant difference between TPPA and TRUST （P 〈 0.05 ）. Conclusion The three kinds of methods can not be used alone to detect treponema pallidum antibody quickly, accurately and economically. It is suggested that we should combine the three detection methods to improve the clinical diagnostic coincidence rate of syphilis effectively.