梅毒螺旋体IgM抗体检测在梅毒诊断中的意义

Significance of IgM antibody detection of Treponema pallidum in diagnosis of syphilis

目的探讨检测血清梅毒螺旋体IgM抗体在梅毒诊断中的临床意义。方法北京佑安医院性病门诊就诊者中已确诊为不同临床分期梅毒患者207例,治疗前采用免疫印迹法(TP-IgM-WB)检测血清中的IgM抗体同时进行快速血浆反应素环状卡片试验(RPR)。患者规范治疗后,每3个月复查1次,1年后每半年复查1次,随访两年。首次RPR检测阴性时,再次进行梅毒螺旋体IgM抗体检测。结果 207例确诊梅毒患者未进行规范治疗前,IgM抗体阳性率和RPR阳性率分别为74.88%、72.95%。各期梅毒患者中TP-IgM-WB及RPR阳性率分别为,一期梅毒86.79%、60.38%;二期梅毒74.11%、83.93%;三期梅毒25.00%、50.00%;隐性梅毒65.79%、60.53%。两种方法相比一期梅毒TP-IgM-WB敏感性比RPR高,差异有统计学意义(P<0.05)。符合规范治疗经随访至两年血清学治愈159例样本中,IgM抗体检测出4例阳性,其中一期梅毒中1例、二期梅毒1例、隐性梅毒2例,经FTA-abs-IgM验证后4例均为阳性。结论梅毒螺旋体IgM抗体在梅毒早期诊断中灵敏度高于RPR。在梅毒患者临床血清治愈判断中,除了RPR试验外,建议加入梅毒螺旋体IgM抗体作为检测指标。

Objective To investigate the clinical significance of IgM antibody detection of Treponema pallidum in patients with syphilis. Methods A total of 207 syphilis cases with different clinical stages were diagnosed in STD clinic of Beijing You’an Hospital. IgM antibody in serum was detected by western blot(TP-IGM-WB) and rapid plasma regain assay(RPR) was performed before treatment. The patients were followed up every three months in the first year and six months in the second year after the standard treatment. IgM antibody of Treponema pallidum was detected again when RPR test was negative for the first time. Results The positive rates of IgM antibody and RPR were 74.88% and 72.95%respectively in 207 confirmed syphilis patients before the standard treatment. The positive rates of TP-IgM-WB and RPR were 86.79% and 60.38% in primary syphilis, 74.11% and 83.93% in secondary syphilis, 25% and 50% in tertiary syphilis;65.79% and 60.53% in latent syphilis. The sensitivity of TP-IGM-WB for primary syphilis was higher than that for RPR in the two methods(P < 0.05). Among the 159 cases with the standard treatment and serologically cured for two years after follow-up, 4 cases were positive for IgM antibody, including 1 case of primary syphilis, 1 case of secondary syphilis, and 2 cases of latent syphilis. All the 4 cases were positive after verification of FTA-abs-IgM. Conclusion The sensitivity of IgM antibody of Treponema pallidum in early diagnosis of syphilis is higher than that of RPR. In addition to RPR test, it is suggested to add IgM antibody of Treponema pallidum as the detection index in clinical serum cure judgment of syphilis patients.