不同血清学检测法诊断儿童梅毒的应用研究

Application of different serological tests in diagnos is of pediatric syphilis

目的探讨三种血清学检测方法在临床诊断儿童梅毒中的应用情况。方法选择沈阳市儿童医院2014年12月至2016年2月门诊及住院患者4 230例,分别进行了以下检测:甲苯胺红不加热血清试验(TRUST)、梅毒螺旋体抗体检测胶体金法(SYP)、梅毒螺旋体明胶凝集试验(TPPA),并对检测结果进行分析。结果用三种方法对血液标本进行检测,经任意一项检测为阳性即视为阳性患者共28例。其中三项检测均为阳性4例(14.3%),有两项检测为阳性11例(39.3%),只有一项检测为阳性13例(46.4%)。确诊阳性患者15例。在检测中TRUST特异度(92.3%)高,但敏感度(40.0%)低;SYP敏感度(86.7%)高,但特异度(7.7%)低,均不适宜单独作为初筛检测试验。应用TRUST和SYP联合检测作为初筛试验,其中任意一种为阳性结果,灵敏度为100.0%。结论用TRUST、SYP联合作为梅毒初筛检测试验;TPPA可以用作梅毒确诊实验;TRUST适宜疗效观察。

Objective To explore the application of three serological tests in clinical diagnosis of pediatric syphilis .Methods Totally 4 230 outpatients and inpatients during December 2014 to February 2016 in Children ’ s Hospital of Shenyang City were selected .Their blood samples were tested and analyzed by Toluidine Red Unheated Serum Test （TRUST）, syphilis antibody colloidal gold method （SYP） and treponema pallidum particle assay （ TPPA）.Results The blood samples were tested by above three tests .Totally 28 patients were considered as syphilis positive because at least one of tests was positive .There were 4 patients positive in all three tests （14.3%）, 11 patients positive in two tests （39.3%）, 13 patients positive in one test （46.4%）.And totally 15 patients were confirmed as positive .In the test, the specificity of TRUST （92.3%） was high, while its sensitivity （40.0%） was low.Sensitivity of SYP （86.7%） was high, while specificity （7.7%） was low.Both of them should not be used singly for primary screening test .In the primary screening test , combination of TRUST and SYP should be used .And the positive result was confirmed by either of them .The sensitivity was 100.0%. Conclusion Combination of TRUST and SYP should be used for primary syphilis screening test .TPPA can be used for diagnosis test of syphilis, and TRUST can be used for observation of clinical effect .