孕妇性传播疾病检测结果假阳性原因探讨

Causes of false-positive detection of sexually transmitted diseases in pregnant women

目的:探讨孕妇在不同孕期丙肝抗体、乙肝表面抗原、梅毒螺旋体抗体、人类免疫缺陷病毒抗体试验假阳性原因,制定日常工作流程。方法:选取2020年9月~2021年11月山东大学齐鲁医院(青岛)查体的各期孕妇1712例(观察组),根据孕周划分为妊娠早期(妊娠12周前)、妊娠中期(妊娠13~27周末)、妊娠后期(妊娠28~41周末),健康对照组为与观察组年龄相近的育龄妇女200例。电化学发光法检测丙型肝炎病毒抗体、乙型肝炎病毒表面抗原、梅毒螺旋体抗体、人类免疫缺陷病毒抗体,间接免疫荧光法检测抗核抗体,化学发光法检测抗心磷脂抗体,细胞磁化法检测不规则抗体。结果:孕期与对照组相比乙肝表面抗原假阳性率明显增高,差异有统计学意义(P<0.05),丙肝抗体、梅毒螺旋体抗体、人类免疫缺陷病毒抗体假阳性率有增加趋势,差异无统计学意义(P>0.05);中晚孕期与早期相比乙肝表面抗原假阳性率明显增高,差异有统计学意义(P<0.05),丙肝抗体、梅毒螺旋体抗体、人类免疫缺陷病毒抗体假阳性率有增加趋势,差异无统计学意义(P>0.05);假阳性标本中,中晚期孕妇抗核抗体明显高于孕早期,差异有统计学意义(P<0.05),不规则抗体、抗心磷脂抗体均有一定程度的阳性率。对所有假阳性标本进行核酸验证,结果均为阴性。结论:孕中晚期孕妇体内可产生一定量的抗核抗体、不规则抗体或抗心磷脂抗体,这些抗体可引起抗原抗体反应,使临床试验结果发生假阳性反应。

Objective:We aim to investigate the causes of false-positive results of hepatitis C antibody(HCV-Ab),hepatitis B surface antigen(HBsAg),treponema pallidum antibody(TP-Ab),and human immunodeficiency virus antibody(HIV-Ab)tests in pregnant women at different stages of pregnancy,and to formulate daily workflow.Methods:A total of 1712 pregnant women(observation group)who underwent physical examination in Qilu Hospital of Shandong University(Qingdao)from September 2020 to November 2021 were selected and divided into early pregnancy(0-12 weeks of gestation),middle pregnancy(13-27 weeks of gestation)and late pregnancy(28-41 weeks of gestation).The control group consisted of 200 women of childbearing age similar to the observation group.The HCV-Ab,HBsAg,TP-Ab,and HIV-Ab were detected by electro-chemiluminescence.The anti-nuclear antibody(ANA)was detected by indirect immunofluorescence.The anti-cardiolipin antibody(ACA)was detected by chemiluminescence.The irregular antibody was detected by erythrocyte magnetization.Results:Compared with the control group,the weak positive rate of HBsAg during pregnancy was significantly higher,and the difference was statistically significant(P<0.05).The weak positive rate of HCV-Ab,TP-Ab,and HIV-Ab had an increasing trend in pregnant women,and the difference was not statistically significant(P>0.05).The weak positive rate of HBsAg was significantly higher in middle and late pregnancy compared with the early pregnancy,and the difference was statistically significant(P<0.05).And the weak positive rate of HCV-Ab,TP-Ab,and HIV-Ab showed an increasing trend,but the difference was not statistically significant(P>0.05).Among the weak positive samples,the positive rate of ANA in the middle and late pregnant women was significantly higher than that in the early pregnancy.The difference was statistically significant(P<0.05).The irregular antibody and ACA had a certain degree of positive rate.Nucleic acid verification was performed on all weak-positive samples,and the results were all negative.Conclusion:A certain amount of ANA,irregular antibody,or ACA can be produced in pregnant women in the middle and late stages of pregnancy,which may cause antigen-antibody reactions and lead to false-positive reactions in clinical trials.