4种检测方法在出入境人员梅毒监测中的应用效果评价

Evaluation of the application effect of four detection methods in syphilis surveillance of entry-exit persons

目的评价甲苯胺红不加热血清试验(TRUST)、化学发光法(CLIA)、电化学发光法(ECL)在出入境人员梅毒监测中的应用效果。方法选取2019年1月—2020年1月在重庆国际旅行卫生保健中心体检的出入境人员血清样本204份,采用TRUST、CLIA、ECL进行检测,以螺旋体明胶颗粒凝集试验(TPPA)为金标准,比较4种方法的检出率、敏感性、特异性、准确率,阳性预测值、阴性预测值和一致性。结果TPPA、TRUST、CLIA和ECL检测梅毒抗体的阳性率分别为66.20%、28.00%、76.90%和72.50%。以TPPA为金标准,TRUST的阳性符合率为96.49%,敏感性、特异性、准确率分别为40.74%、97.10%、59.80%;CLIA的阳性符合率为84.71%,敏感性、特异性、准确率分别为98.52%、65.22%、87.25%;ECL的阳性符合率为91.16%,敏感性、特异性、准确率分别为99.26%、81.16%、94.14%。结论TPPA、TRUST、CLIA、ECL的准确率、敏感性、特异性各有千秋,出入境人员梅毒监测应该用CLIA或ECL初筛,然后用TPPA联合TRUST确证,更好地提供诊断依据。

Objective To evaluate the application of toluidine red unheated serum test(TRUST),chemiluminescence(CLIA)and electrochemiluminescence(ECL)in the surveillance of syphilis among entry-exit personnel.Methods A total of 204 serum samples of entry-exit personnel who underwent physical examination in Chongqing International Travel Healthcare Center from January 2019 to January 2020 were selected.TRUST,CLIA and ECL were used for detection,and treponemalpallidum particle agglutination test(TPPA)was used as the gold standard to compare the detection rate,sensitivity,specificity,accuracy and positive predictive value,negative predictive value,and consistency of the four methods.Results The positive rates of TPPA,TRUST,CLIA and ECL were 66.20%,28.00%,76.90% and 72.50%,respectively.Using TPPA as the gold standard,the positive coincidence rate of TRUST was 98.48%,the sensitivity,specificity and accuracy were 40.74%,97.10% and 59.80%,respectively.The positive coincidence rate of CLIA was 84.71%,and the sensitivity,specificity and accuracy were 98.52%,65.22% and 87.25%,respectively.The positive coincidence rate of ECL was 91.16%,and the sensitivity,specificity and accuracy were 99.26%,81.16%and 94.14%,respectively.Conclusion The accuracy,sensitivity and specificity of TPPA,TRUST,CLIA and ECL were different.CLIA or ECL should be used for preliminary detection in entry-exit syphilis screening,and then TPPA and TRUST should be used for confirmation,so as to provide a better diagnostic reference.