三种梅毒血清学检测策略在临床梅毒诊断中的应用研究

Analysis of three serological testing algorithms for syphilis diagnosis

目的探讨不同梅毒血清学检测策略在梅毒诊断中的应用。方法按照正向策略、反向策略和欧洲疾病控制与预防中心(ECDC)反向策略三种流程,采用甲苯胺红不加热血清学实验(TRUST),梅毒螺旋体抗体明胶颗粒凝集试验(TPPA)和梅毒螺旋体抗体化学发光试验(CLIA)检测所有血清标本,比较3种检测策略对梅毒的检出价值。结果选择865例梅毒患者作为梅毒组,再选择同期排除梅毒的患者100例作为对照组,3种方法对不同分组的梅毒检出率差异均有统计学意义(P均<0.05);TRUST、CLIA和TPPA的检出敏感性分别为87.28%,99.88%,99.54%,特异性分别为98.00%,97.00%,100.00%,准确度分别为88.39%,99.59%,99.59%;正向策略、反向策略和ECDC反向策略的敏感性分别为85.20%、99.42%、99.54%,特异性分别为98.00%、97.00%、100.00%,准确度分别为86.53%、99.17%、99.59%。结论不同梅毒血清学检测方法检测性能不一致,反向策略或ECDC反向策略具有更好的敏感性、特异性和准确度,适用于临床筛查和诊断。

Objective To evaluate the performance of the different serological testing algorithms for syphilis diagnosis.Methods A total of 865 patients with syphilis were enrolled as syphilis group,and 100 patients without syphilis in the same period were enrolled as control group.All the samples were tested by toluidine red unheated serum test(TRUST),T.pallidum particle agglutination assay(TPPA)and chemiluminescence immune assay(CLIA).The significance of 3 single determinations and different testing algorithms was compared.Results The 3 methods had statistical significance(P<0.05)in all the groups.The sensitivities of TRUST,CLIA and TPPA were87.28%,99.88%and 99.54%;the specificities were 98.00%,97.00%and 100.00%;the accuracies were88.39%,99.59%and 99.59%.The sensitivities of traditional algorithm,reverse algorithm and European Centre for Disease Prevention and Control(ECDC)reverse algorithm were 85.20%,99.42%and 99.54%,with the specificities of 98.00%,97.00%and 100.00%,and the accuracies of 86.53%,99.17%and 99.59%.Conclusion The reverse algorithm and ECDC reverse algorithm can improve the accuracy of syphilis determination.