梅毒患者实验室检测结果评价

Evaluation of the laboratory results of patients with syphilis

目的探讨不同组合的血清学检测在梅毒诊断中的价值。方法收集2016年9月~2017年8月在北京地坛医院就诊的20 325例患者血清,分别应用甲苯胺红不加热血清试验(TRUST)、梅毒螺旋体明胶凝集试验(TPPA)和荧光密螺旋体抗体吸收试验(FTA)检测梅毒血清样本。结果 20 325例患者中,有4480例确诊为梅毒螺旋体感染,在4480例TPPA阳性TP患者中,TRUST阳性者3342例,占74.6%;TRUST阴性者1138例,占25.4%;其中在3342例TPPA阳性,TRUST阳性的梅毒(TP)患者中,FTA-ABS-Ig M阳性者979例,占29.3%;在1138例TPPA阳性,TRUST阴性的TP患者中,FTA-ABS-Ig M阳性者12例,占1.05%;979例梅毒患者FTA-ABS-Ig M阳性率与TRUST不同稀释倍数呈对数相关(R2=0.9351)。结论对于开展梅毒血清学检测的实验室,应该同时进行TPPA和TRUST两种梅毒抗体的检测,在TRUST阴性和治疗后TRUST持续阳性的情况下,FTA-ABS-Ig M可作为其他两种方法的有效补充。

Objective To investigate the value of different combinations of serological tests in the diagnosis of syphilis.Methods The serum of 20 325 patients visited Beijing Ditan Hospital from September 2016 to August 2017 were collected.Three methods including toluene red unheated serum test（TRUST）,treponema pallidum gelatin agglutination test（TPPA） and fluorescent treponema pallidum antibody absorption test（FTA） were used to test the syphilis antibodies in the serum sample.Results Among the 20 325 patients,4480 were diagnosed with treponema pallidum（TP） infection and among these patients with TPPA-positive,3342 cases were positive for TRUST,accounted for 74.6%;1138 cases were negative for TRUST,accounted for 25.4%.Among 3342 cases of TPPA-positive and TP-positive patients,979 cases were positive for FTA-ABS-Ig M,accounted for 29.3%.Among 1138 cases of TPPA-positive and TRUST-negative patients,12 cases were positive for FTA-ABS-Ig M,accounted for 1.05%.The positive rate of Ig M antibody in 979 patients with syphilis was logarithmically correlated with different dilutions of the TRUST（R2= 0.9351）.Conclusion For laboratories that carried out syphilis serological tests,TPPA and TRUST should be carried out simultaneously.FTA-ABS-Ig M was an effective complement for two other methods with TRUST-negative and TRUST persistent positive after treatment.