酶联免疫吸附试验检测梅毒患者血清中抗苍白螺旋体IgM抗体

Detection of serum anti-treponema pallidum IgM antibody in patients with syphilis by using ELISA

目的 评价抗苍白螺旋体IgM抗体检测对梅毒的临床意义。方法 用酶联免疫吸附试验 (ELISA)对 72例梅毒患者检测了特异性IgM抗体 ,并与快速血浆反应素环状卡片试验 (RPR)、梅毒螺旋体明胶颗粒凝集试验(TPPA)的检测结果进行比较分析。结果 血清抗苍白螺旋体IgM抗体在一期梅毒的阳性率为 73 3% (11/ 15 ) ,在二期梅毒的阳性率为 88 9% (16 / 18) ,二者差异无显著的统计学意义 (χ2 =1 6 36 3,P >0 10 )。在潜伏梅毒 ,IgM抗体阳性率为 2 6 1% (6 / 2 3) ,非常显著地低于早期显性梅毒 (χ2 =17 6 189,P <0 0 0 5 )。在一期、二期和潜伏梅毒 ,RPR和TPPA的阳性率均为 10 0 %。入组前 2～ 2 4个月已经正规抗梅治疗的梅毒 16例 ,其中IgM抗体阳性2例。结论 ELISA法检测特异性IgM抗体诊断一期梅毒并不优于RPR和TPPA。IgM抗体在潜伏梅毒敏感性低 ,其诊断应依靠RPR和TPPA。目前不推荐单独检测抗梅毒IgM抗体来监测病情和判断疗效。

objective To evaluate t he clinical significance of serum IgM antibody detection for to treponema pallidu m in syphilis patients Methods Sev enty two cases of syphilis were teste d for specific IgM antibody with E LISA,and the results were compared with RPR and TPPA Results The po sitive rate of IgM antibody in patie nts with primary syphilis was 73 3 %(11/15),and was 88 9%(16/18)in patients w ith secondary syphilis,and there w as no significant difference betwe en them(χ 2=1 6363,P>0 10) The posi tive rate of IgM antibody in laten t syphilis was only 26 1%(6/23),mu ch lower than in early symptomatic syphilis(χ 2=17 6189,P<0 005),RPR or TPPA were both 100% positive in latent and early symptomatic syphi lis Two were positive for IgM in 1 6 cases who had received regular t reatments for 2-24 months before e nrollment Conclusions In our stu dy,specific IgM antibody detection i s not superior to RPR or TPPA in diagnosing primary syphilis The di agnosis of latent syphilis should mainly rely on RPR and TPPA,owing to the low sensitivity of IgM anti body under that condition And pres ently,IgM antibody detection alone should not be recommended for moni toring disease activity and evalua ting treatment response in syphili s Further intensive studies in tha t field are needed