不同的梅毒血清学试验方法检测1 808例血清标本结果分析

目的结合患者临床资料,比较快速血浆反应素环状卡片试验(RPR)、梅毒螺旋体特异性抗体化学发光法(CLIA)和梅毒螺旋体明胶颗粒凝集试验(TPPA)检测梅毒的优缺点。方法 1 808例标本分别采用RPR法和CLIA法检测,结果阳性的标本再用TPPA法复测。结果1 808例患者中共确诊170例梅毒感染患者。RPR法敏感性和阳性预测值较低,与CLIA法和TPPA法相比差异有统计学意义(P<0.05);RPR法特异性与CLIA法相比差异无统计学意义(P>0.05);阴性预测值低于CLIA法,差异有统计学意义(P<0.05)。CLIA法敏感性与TPPA法相比差异无统计学意义(P>0.05),阳性预测值低于TPPA法,差异有统计学意义(P<0.05)。三种方法均存在一定的生物学假阳性,RPR法和TPPA法存在一定的假阴性。结论梅毒血清学试验CLIA法和TPPA法在梅毒诊断方面优于RPR法,建议改进梅毒检测流程并且结合流行病史、临床资料及实验室检查结果综合判断。

Different serological tests for syphilis in 1,808 specimens

ObjectiveTo identify the advantages and disadvantages of the rapid plasma reagin test (RPR), chemiluminescence immunoassay (CLIA) and Treponema pallidum particle agglutination test (TPPA) for detecting syphilis. MethodsA total of 1,808 serum specimens were detected by RPR and CLIA; the negative specimens as detected by CLIA and by RPR were redetected by TPPA.ResultsThere were 170 syphilis patients among the 1,808 patients.The sensitivity and positive predictive value of RPR were both significantly lower than those of CLIA and TPPA (P<0.05). The specificities were not significantly different between CLIA and RPR(P>0.05). However, the negative predictive value of RPR was significantly lower than that of CLIA (P<0.05). The sensitivities were not significantly different between CLIA and TPPA(P>0.05); however, the positive predictive value of CLIA was significantly lower than that of TPPA (P<0.05). Biologically false positive results could be found for all the 3 methods and false negative results could be found for RPR and TPPA (P<0.05). ConclusionCLIA and TPPA are superior to RPR in diagnosing syphilis. The procedure of diagnosing syphilis may need to be adjusted, and syphilis should be diagnosed by combining the medical history, symptom and lab results.