梅毒螺旋体抗体血清学检测方法的临床应用价值探讨

Analysis on the clinical value of methods used for the detection of treponema pallidum antibody

目的探讨5种常用的梅毒螺旋体抗体血清学检测方法的临床应用价值。方法收集160例梅毒确诊病例血清标本作为试验组，非梅毒者200例血清标本作为对照组，两组血清标本采用梅毒螺旋体明胶颗粒凝集试验（TPPA）、化学发光微粒子免疫分析法（CMIA）、ELISA、乳胶法（TP—AD）和甲苯胺红不加热血清试验（TRUST）对梅毒螺旋体抗体进行检测，评价5种检测方法的敏感度、特异度，并比较5种方法对各期梅毒患者治疗前后检测的结果。结果5种梅毒检测方法的敏感度和特异度：TPPA为100．00％和99．50％、CMIA为99．38％和99．00％、ELISA为98．12％和99．00％、TP．AD为94．38％和94．50％、TRUST为85．62％和95．50％。在一期梅毒和隐性梅毒患者中，TRUST法检测的梅毒螺旋体抗体阳性率低于TPPA、ELISA、CMIA和TP．AD法检测，差异有统计学意义（P〈0．01）；在二期、三期梅毒患者中，5种方法检测的梅毒螺旋体抗体阳性率差异无统计学意义（P〉0．05）；在各期梅毒患者中，ELISA或CMIA联合TRUST检测的梅毒螺旋体抗体阳性率均为100．00％。121例梅毒患者治疗前后，TRUST法检测的梅毒螺旋体阳性率差异有统计学意义（P〈0．05），其他4种检测方法检测的阳性率差异无统计学意义（P〉0．05）。结论TPPA、CMIA和ELISA法的敏感度和特异度较好，ELISA或CMIA联合TRUST是各期梅毒患者筛查的可靠方法，TRUST适宜梅毒活动期判定和疗效监测。

Objective To explore the clinical value of five methods commonly used for the detection of clinical syphilis antibody. Methods A total of 160 confirmed syphilis cases were chosen as the experimental group while 200 non-syphilis cases were set as the control group. Serum specimens were detected by methods as Treponema pallidum particle agglutination assay （TPPA）, chemilumineseent microparticle immune assay （CMIA）, enzyme linked immunosorbent assay （ELISA）, emulsion method （TP-AD） and toluidine red unheated serum test （TRUST）. Sensitivity and specificity were evaluated on five methods. Titers of syphilis antibody in different stages and pre/post on treatment among syphilis patients were compared and analyzed under the five methods. Results The sensitivity vs. specificity of TPPA, CMIA, ELISA, TP-AD and TRUST appeared as 100.00% vs. 99.50%, 99.38% vs. 99.00%, 98.12% vs. 99.00%, 94.38% vs. 94.50% and 85.62% vs. 95.50%, respectively. Among the patients at primary or latent stages, the syphilis antibody positive rate detected by TRUST appeared lower than that detected by ELISA, TPPA, CMIA or TP-AD, and the differences were statistically significant （P〈0.01）. There were no statistical differences in the syphilis antibody positive rate of syphilis patients in the secondary or tertiary stages detected by five methods （P〉0.05）. In each stage of the syphilis patients, the syphilis antibody positive rate detected by ELISA or of CMIA combined with TRUST both reached 100.00%. Before and after treatment in 121 cases of confirmed syphilis, there was statistically significant difference in the syphilis antibody positive rate detected by TRUST method （P〈0.05）. There was no statistical significance in the syphilis antibody positive rate detected by other four methods （P〉0.05）. Conclusions The sensitivity and specificity of TPPA, CMIA and ELISA methods were better. Methods as ELISA or as CMIA combined with TRUST both appeared reliable for syphilis screening in every stage of the disease. TRUST was suitable for the determination of active stage syphilis and monitoring the effects after treatment.