5种常用的梅毒螺旋体抗体血清学检测方法的应用价值

Application value of 5 kinds of commonly methods for the detection of treponema pallidum antibody

目的评价甲苯胺红不加热血清试验(TRUST)、快速血浆反应素环状卡片试验(RPR)、酶联免疫吸附试验(ELISA)、全自动微粒子化学发光免疫实验(CMIA)、梅毒螺旋体明胶颗粒凝集试验(TPPA)5种方法检测梅毒螺旋体抗体的临床应用价值。方法收集2016年1月至2016年12月临床确诊为梅毒的患者180例为观察组,选取同期健康体检者200例为对照组,采用TRUST、RPR、ELISA、CMIA、TPPA检测两组血清标本中梅毒螺旋体抗体,并比较5种方法的灵敏度、特异度。结果 5种方法检测的灵敏度、特异度分别为:TRUST为85.6%、95.5%,ELISA为98.3%、99.0%,CMIA为99.4%、99.0%,TPPA为100.0%、99.5%,RPR为85.0%、95.0%。TRUST、RPR检测一期梅毒和隐性期梅毒患者梅毒螺旋体抗体的阳性率均低于其他3种方法(P<0.05);5种方法检测二期、三期梅毒患者梅毒螺旋体抗体的阳性率比较,差异无统计学意义(P>0.05);ELISA、CMIA、TPPA检测各期梅毒患者梅毒螺旋体抗体的阳性率比较,差异无统计学意义(P>0.05)。结论 5种梅毒螺旋体抗体血清学检测方法各有适用性。建议采用ELISA或CMIA联合TRUST或RPR进行初筛,经TPPA进行确诊。

Objective To evaluate the clinical value of toluidine red unheated serum test（TRUST）, rapid plasma regain test（RPR）, enzyme-linked immunosorbent assay（ELISA）, automatic chemiluminescence immune experiment particles（CMIA）, treponema pallidum gelatin particle agglutination test（TPPA） for the detection of treponema pallidum antibody.Methods A total of 180 patients who clinically diagnosed with syphilis from January 2016 to December 2016 were collected as observation group, and 200 healthy medical examiners were selected as control group at the same time. The serum antibodies of treponema pallidum antibody were detected in the two groups by methods as TRUST, RPR, ELISA, CMIA and TPPA. The sensitivity and specificity of 5 methods were compared. Results The sensitivity and specificity of the five methods were 85.6% and 95.5% for TRUST, 98.3% and 99.0% for ELISA, 99.4% and 99.0% for CMIA, 100.0% and 99.5%for TPPA, 85.0% and 95.0% for RPR, respectively. The treponema pallidum antibody positive rate detected by TRUST and RPR among patients at primary or latent stages was lower than that of the other three methods（P〈0.05）; there were no statistically significant differences in the treponema pallidum antibody positive rate detected by 5 methods among patients at secondary or tertiary stages（P〈0.05）; there was no significant difference in the treponema pallidum antibody positive rate detected by ELISA, CMIA and TPPA among patients in every stage of the disease（P〈0.05）. Conclusion The five methods for the detection of treponema pallidum antibody were applicable. It is suggested to use the ELISA or CMIA joint TRUST or RPR for initial screening, and TPPA can be used to confirm the diagnosis.