心血管疾病患者梅毒检测结果分析

Analysis of syphilis detection results in patients with cardiovascular disease

目的:分析心血管疾病患者梅毒血清学特点,为降低其发病率制定相关防控措施以及临床手术生物安全防护提供实验室依据。方法:回顾性分析云南省阜外心血管医院2018年1月-2021年12月心血管疾病患者52025例,通过采集患者空腹静脉血清用酶联免疫吸附实验(ELISA)初筛,阳性患者用梅毒甲苯胺红不加热血清实验进行复检。将患者按性别、年龄、入院时间和血清检测方法学进行分析,随机抽取同时期TP-ELISA阳性患者297例和TP-ELISA阴性患者300例与心血管疾病类型进行分析。结果:52025例病人中TP-ELISA阳性、TRUST阳性分别为698例、149例,TP-ELISA总阳性率1.3%高于TRUST总阳性率0.3%,差异有统计学意义(X^(2)=358.8,P<0.01);男性TP-ELISA和TRUST阳性率分别为1.7%和0.3%高于女性0.9%和0.2%差异有统计学意义(X^(2)=57.3和4.5,P<0.01和P<0.05);各年龄段TP-ELISA和TRUST阳性率差异有统计学意义(X^(2)=138.6和90.7,均为P<0.01)其中≤20岁阳性率最低TP-ELISA 0.1%、TRUST0.001%,≥81岁阳性率最高TP-ELISA2.6%、TRUST 1.3%;TP-ELISA阳性患者主动脉和主动脉瓣膜相关性疾病患病率均高于TP-ELISA阴性患者(X^(2)=13.1和5.3,P=0.01和0.02)。结论:心血管疾病患者梅毒抗体阳性率男性大于女性;且随着年龄的增长有上升的趋势,老年心血管疾病患者梅毒阳性率较高;应加强梅毒相关性病知识的普及和预防;梅毒特异性抗体阳性率高于非梅毒特异性抗体阳性率,在临床工作中应重视梅毒血清学实验的选择和结果解读,TP-ELISA阳性患者主动脉和主动脉瓣膜相关性疾病患病率显著升高,可能由梅毒螺旋体所致,临床医生应注重生物安全防护。

Objective:To analyze the serological characteristics of syphilis in patients with cardiovascular disease,and to provide a laboratory basis for reducing its incidence rate to formulate relevant prevention and control measures,and provide biological safety protection for clinical surgery.Methods:A retrospective analysis was conducted on 52025 patients with cardiovascular diseases at Fuwai Cardiovascular Hospital in Yunnan Province from January 2018 to December 2021.Fasting venous serum was collected from the patients and an enzyme-linked immunosorbent assay(ELISA)was used for initial screening.Positive patients were retested using Treponema pallidum red unheated serum test(TRUST).Analyze patients by gender,age,admission time,and serum testing methodology.Randomly select 297 TP-ELISA positive patients and 300 TP-ELISA negative patients from the same period for analysis based on the type of cardiovascular disease.Results:Among the 52025 patients,698 were TP-ELISA positive and 149 were TRUST positive,respectively.The total positive rate of TP-ELISA was 1.3%,which was higher than the total positive rate of TRUST which was 0.3%.The difference was statistically significant(X^(2)=358.8,P<0.01);The positive rates ofTP-ELISA and TRUST in males were 1.7%and 0.3%,respectively,which were higher than those in females by 0.9%and 0.2%.The difference was statistically significant(X^(2)=57.3 and 4.5,P<0.01 and P<0.05);There was a statistically significant difference in the positive rates of TP-ELISA and TRUST among different age groups(X^(2)=138.6 and 90.7,both P<0.01).Among them,TP-ELISA had the lowest positive rates of 0.1%and TRUST 0.001%for those≤20 years old,and TP-ELISA had the highest positive rates of 2.6%and TRUST 1.3%for those≥81 years old;The prevalence of aortic and aortic valve related diseases in TP-ELISA positive patients is higher than that in TP-ELISA negative patients(X^(2)=13.1 and 5.3,P=0.01 and 0.02).Conclusion:The positive rate of syphilis antibodies in cardiovascular disease patients is higher in males than in females;And there is an upward trend with age,with a higher positive rate of syphilis in elderly cardiovascular disease patients;We should strengthen the dissemination and prevention of knowledge about syphilis related sexually transmitted diseases;The positive rate of syphilis specific antibodies is higher than that of non-syphilis specific antibodies.In clinical work,attention should be paid to the selection and interpretation of syphilis serological experiments.TP-ELISA-positive patients have a significantly higher incidence of aortic and aortic valve-related diseases,which may be caused by Treponema pallidum.Clinicians should pay attention to biosafety protection.