梅毒螺旋体明胶凝集试验定量检测在神经梅毒诊疗中的临床意义

Value of quantitative TPPA test in diagnosis and treatment of neurosyphilis

目的探讨梅毒螺旋体明胶凝集试验(TPPA)定量检测在神经梅毒诊疗中的应用。方法统计神经梅毒患者初次确诊时脑脊液性病研究实验室试验(VDRL)、快速血浆反应素环状卡片试验(RPR)、TPPA、梅毒螺旋体抗体吸收试验(FTA-ABS)IgG、FTA-ABS IgM和血清RPR的检验数据,治疗规范半年后、1年后复查上述检验项目,分析3次数据与治疗效果的关系。结果经规范治疗后,神经梅毒患者脑脊液TPPA的滴度逐渐下降,半年稀释倍数与首次相比(t=3.533,P=0.002)、1年稀释倍数与首次相比(t=4.555,P=0.000),差异均有统计学意义;有2例患者脑脊液TPPA转为阴性;TPPA稀释倍数与脑脊液RPR(r=0.430 1,P=0.031 9)、VDRL(r=0.703 7,P=0.000 1)稀释倍数呈相关性;脑脊液TPPA稀释倍数与血清RPR稀释倍数无相关性;脑脊液和血清TPPA定性结果与FTA-ABS IgG完全一致。结论 TPPA定量检测与VDRL、RPR相比,对神经梅毒疗效观察有较好的价值。

Objective To assess the effect of the quantitative treponemal pallidum particle agglutination(TPPA)test in diagnosis and treatment of neurosyphilis.Methods 25 cerebrospinal fluid(CSF)specimens of neurosyphilis were detected by venereal disease research laboratory test(VDRL),rapid plasma reagin test(RPR),quantitative TPPA test,IgG/IgM of FTA-ABS(fluoresent treponemal antibody absorption test),and serum specimens were detected by RPR.After six months of treatment and one year later,the above detection indicators were repeatedly tested.Results After treatment of neurosyphilis,the TPPA dilution multiples in CSF gradually decreased(t=3.533,P=0.002),and those of 2 patients turned negative.TPPA dilution multiples in CSF were related to VDRL(r=0.703 7,P=0.0001)and RPR(r=0.430 1,P=0.031 9)dilution multiples in CSF,respectively.TPPA dilution multiples in CSF had no relation with RPR dilution multiples in serum(r=0.096 43,P=0.646 9).CSF and serum TPPA qualitative results were completely consistent with that of FTA-ABS IgG.Conclusion Compared with VDRL and RPR,the quantitative detection of TPPA has a better value in the observation of curative effect of neurosyphilis.