CAJ | 학술논문

目的：研究三种常用的不同血清学诊断方法对梅毒螺旋抗体的检测效果，从而为提高梅毒螺旋抗体的检出率提供较好的诊断方法。方法：选取2013年1月至2014年7月于我科门诊就诊的274例患者为观察对象，根据有无感染梅毒将其分为两组，其中177例感染梅毒患者为观察组，97例非梅毒患者为对照组，分别应用酶联免疫吸附试验（ELISA）、梅毒螺旋体明胶颗粒凝集试验（TPPA）、甲苯胺红不加热血清试验（TRUST）三种常用的不同血清学诊断方法对两组患者进行梅毒螺旋抗体的检测，分别比较三种检测方法检测的梅毒螺旋抗体的阳性例数、敏感性和特异性，并进行分析。结果：在检测梅毒患者血清标本的阳性率方面，ELISA 法最高，为98.87％，TRUST 法最低，为88.70％，ELISA 法与 TPPA 法比较，差异无统计学意义（P ＞0.05），TRUST 法分别与 ELISA 法、TPPA 法比较，差异均具有统计学意义（P ＜0.05）；ELISA 法、TRUST法、TPPA 法检测梅毒患者血清的敏感性分别为98.87％、88.70％、97.18％，特异性分别为98.97％、95.88％、100.00％，阴性预测值分别为97.96％、82.30％、95.10％，阳性预测值分别为99.43％、97.52％、100.00％；ELISA 法敏感性和阴性预测值最高，与 TRUST 法比较，差异有统计学意义（P ＜0.05）；TPPA 法特异性和阳性预测值最高，与 TRUST 法比较，差异有统计学意义（P ＜0.05）；三种血清学检测方法同时显示梅毒患者血清阳性者有155例，同时显示阴性者有1例，TRUST 法显示阴性而 TPPA 法和 ELISA 法显示阳性者17例。结论：三种血清学检测方法的侧重点各不相同，ELISA 法适用于大批量样本筛查、TPPA 法适用于进行梅毒确诊、TRUST 法应用于对梅毒患者治疗疗效及预后的判断，在临床中应结合实际情况进行选择。
목적：연구삼충상용적불동혈청학진단방법대매독라선항체적검측효과，종이위제고매독라선항체적검출솔제공교호적진단방법。방법：선취2013년1월지2014년7월우아과문진취진적274례환자위관찰대상，근거유무감염매독장기분위량조，기중177례감염매독환자위관찰조，97례비매독환자위대조조，분별응용매련면역흡부시험（ELISA）、매독라선체명효과립응집시험（TPPA）、갑분알홍불가열혈청시험（TRUST）삼충상용적불동혈청학진단방법대량조환자진행매독라선항체적검측，분별비교삼충검측방법검측적매독라선항체적양성례수、민감성화특이성，병진행분석。결과：재검측매독환자혈청표본적양성솔방면，ELISA 법최고，위98.87％，TRUST 법최저，위88.70％，ELISA 법여 TPPA 법비교，차이무통계학의의（P ＞0.05），TRUST 법분별여 ELISA 법、TPPA 법비교，차이균구유통계학의의（P ＜0.05）；ELISA 법、TRUST법、TPPA 법검측매독환자혈청적민감성분별위98.87％、88.70％、97.18％，특이성분별위98.97％、95.88％、100.00％，음성예측치분별위97.96％、82.30％、95.10％，양성예측치분별위99.43％、97.52％、100.00％；ELISA 법민감성화음성예측치최고，여 TRUST 법비교，차이유통계학의의（P ＜0.05）；TPPA 법특이성화양성예측치최고，여 TRUST 법비교，차이유통계학의의（P ＜0.05）；삼충혈청학검측방법동시현시매독환자혈청양성자유155례，동시현시음성자유1례，TRUST 법현시음성이 TPPA 법화 ELISA 법현시양성자17례。결론：삼충혈청학검측방법적측중점각불상동，ELISA 법괄용우대비량양본사사、TPPA 법괄용우진행매독학진、TRUST 법응용우대매독환자치료료효급예후적판단，재림상중응결합실제정황진행선택。
Objectives:To investigate three kinds of commonly used different serological diagnostic methods for detecting the effect of syphilis antibodies,thusly providing better diagnostic methods in order to improve the de-tection rate of syphilis antibodies.Methods:274 patients in my outpatient clinic from January 2013 to July 2014 were selected and,according to the presence or absence of syphilis infection,were divided into two groups:177 ca-ses of syphilis patients in the observation group,and 97 cases of non -syphilis patients in the control group.3 kinds of commonly used serological diagnostic methods,i.e.enzyme -linked immunosorbent assay (ELISA),Treponema pallidum particle agglutination test (TPPA)and toluidine red unheated serum test (TRUST)were used to detect syphilis antibodies of both groups.The number of treponema antibody positive cases,the sensitivity and specificity of the three detection methods were compared and analyzed.Results:ELISA (98.87%)had the highest positive rate of serum samples and TRUST (88.70%)had the lowest,without statistically significant difference between TP-PA and ELISA (P >0.05),but statistically significant difference between TRUST and ELISA /TPPA (P <0.05). The sensitivity of ELISA,TRUST and TPPA was 98.87%,88.70% and 97.18%;specificity was 98.97%, 95.88% and 100.00%;negative predictive values was 97.96%,82.30% and 95.10%;and positive predictive value was 99.43%,97.52% and 100.00%.ELISA had the highest sensitivity and negative predictive value, which was statistically and significant different from the TRUST (P <0.05);TPPA had the highest specificity and positive predictive value,with statistically significant difference from the TRUST (P <0.05).155 cases were found positive by all the 3 methods;1 case was found negative;17cases were found negative by TRUST and positive by TPPA and ELISA.Conclusion:The 3 serological detection methods are of different advantages:ELISA applies to large quantities of sample screening;TPPA law applies to syphilis diagnosis,and TRUST method applies to syphilis therapy and prognosis.Therefore,it should be choosen combined with the actual situation in clinical.