中国医药
中國醫藥
중국의약
China Medicine
2015年
12期
1856-1858
,共3页
神经梅毒%荧光螺旋体抗体吸附试验%梅毒螺旋体明胶颗粒凝集试验%甲苯胺红不加热血清试验
神經梅毒%熒光螺鏇體抗體吸附試驗%梅毒螺鏇體明膠顆粒凝集試驗%甲苯胺紅不加熱血清試驗
신경매독%형광라선체항체흡부시험%매독라선체명효과립응집시험%갑분알홍불가열혈청시험
Neurosyphilis%Fluorescent treponemal antibody absorption test%Syphilis gelatin particle agglutination test%Toluidine red unheated test experiment
目的 评估3种方法对梅毒的临床诊断价值.方法 对2012年2-12月首都医科大学附属北京安贞医院及首都医科大学附属地坛医院门诊及住院疑似梅毒患者483例采用甲苯胺红不加热血清试验(TRUST)、梅毒螺旋体明胶颗粒凝集试验(TPPA)、荧光螺旋体抗体吸附试验(FTA-ABS)进行梅毒血清及脑脊液检测,梅毒血清学阳性的患者进行常规驱梅治疗,半年后复查并评价3种方法学单独及联合检测的敏感度及特异度.结果 483例患者中,神经梅毒52例,先天梅毒6例,隐性梅毒31例,一期梅毒36例,二期梅毒149例,三期梅毒98例,非梅毒患者111例.以临床诊断为金标准,431例非神经梅毒的疑似梅毒患者中血清TRUST诊断梅毒的敏感度和特异度分别为84.4％、94.6％,TPPA诊断梅毒的敏感度和特异度分别为100.0％,99.1％, FTA-ABS诊断梅毒的敏感度和特异度分别为100.0％,99.1％,联合诊断的敏感度和特异度均为100.0％.52例神经梅毒患者中,脑脊液TRUST检测阳性31例(59.6％),TPPA检测阳性52例(100.0％),FTA-ABS检测阳性52例(100.0％),联合检测阳性52例(100.0％).治疗半年后,52例神经梅毒患者复查脑脊液TRUST、TPPA及FTA-ABS,TRUST转阴率为35.5％ (11/31),滴度下降率71.2％(37/52),滴度＜1:4,TPPA及HTA-ABS均阳性;复查血清TRUST、TPPA及FTA-ABS,血清TRUST转阴率为7.7％ (4/52),滴度下降率51.9％ (27/52),滴度＜1:16,TPPA及FTA-ABS均阳性;脑脊液TRUST转阴率明显高于血清TRUST转阴率,差异有统计学意义(P＜0.05).结论 脑脊液TRUST可作为梅毒疗效观察的检测方法.FFA-ABS作为确诊试验有一定优势,应联合TPPA作为神经梅毒的确诊标准,实验室对于脑脊液梅毒的筛查诊断还应该以TPPA为主,联合TRUST作为疗效观察指标,联合FTA-ABS作为梅毒确诊实验指标.
目的 評估3種方法對梅毒的臨床診斷價值.方法 對2012年2-12月首都醫科大學附屬北京安貞醫院及首都醫科大學附屬地罈醫院門診及住院疑似梅毒患者483例採用甲苯胺紅不加熱血清試驗(TRUST)、梅毒螺鏇體明膠顆粒凝集試驗(TPPA)、熒光螺鏇體抗體吸附試驗(FTA-ABS)進行梅毒血清及腦脊液檢測,梅毒血清學暘性的患者進行常規驅梅治療,半年後複查併評價3種方法學單獨及聯閤檢測的敏感度及特異度.結果 483例患者中,神經梅毒52例,先天梅毒6例,隱性梅毒31例,一期梅毒36例,二期梅毒149例,三期梅毒98例,非梅毒患者111例.以臨床診斷為金標準,431例非神經梅毒的疑似梅毒患者中血清TRUST診斷梅毒的敏感度和特異度分彆為84.4％、94.6％,TPPA診斷梅毒的敏感度和特異度分彆為100.0％,99.1％, FTA-ABS診斷梅毒的敏感度和特異度分彆為100.0％,99.1％,聯閤診斷的敏感度和特異度均為100.0％.52例神經梅毒患者中,腦脊液TRUST檢測暘性31例(59.6％),TPPA檢測暘性52例(100.0％),FTA-ABS檢測暘性52例(100.0％),聯閤檢測暘性52例(100.0％).治療半年後,52例神經梅毒患者複查腦脊液TRUST、TPPA及FTA-ABS,TRUST轉陰率為35.5％ (11/31),滴度下降率71.2％(37/52),滴度＜1:4,TPPA及HTA-ABS均暘性;複查血清TRUST、TPPA及FTA-ABS,血清TRUST轉陰率為7.7％ (4/52),滴度下降率51.9％ (27/52),滴度＜1:16,TPPA及FTA-ABS均暘性;腦脊液TRUST轉陰率明顯高于血清TRUST轉陰率,差異有統計學意義(P＜0.05).結論 腦脊液TRUST可作為梅毒療效觀察的檢測方法.FFA-ABS作為確診試驗有一定優勢,應聯閤TPPA作為神經梅毒的確診標準,實驗室對于腦脊液梅毒的篩查診斷還應該以TPPA為主,聯閤TRUST作為療效觀察指標,聯閤FTA-ABS作為梅毒確診實驗指標.
목적 평고3충방법대매독적림상진단개치.방법 대2012년2-12월수도의과대학부속북경안정의원급수도의과대학부속지단의원문진급주원의사매독환자483례채용갑분알홍불가열혈청시험(TRUST)、매독라선체명효과립응집시험(TPPA)、형광라선체항체흡부시험(FTA-ABS)진행매독혈청급뇌척액검측,매독혈청학양성적환자진행상규구매치료,반년후복사병평개3충방법학단독급연합검측적민감도급특이도.결과 483례환자중,신경매독52례,선천매독6례,은성매독31례,일기매독36례,이기매독149례,삼기매독98례,비매독환자111례.이림상진단위금표준,431례비신경매독적의사매독환자중혈청TRUST진단매독적민감도화특이도분별위84.4％、94.6％,TPPA진단매독적민감도화특이도분별위100.0％,99.1％, FTA-ABS진단매독적민감도화특이도분별위100.0％,99.1％,연합진단적민감도화특이도균위100.0％.52례신경매독환자중,뇌척액TRUST검측양성31례(59.6％),TPPA검측양성52례(100.0％),FTA-ABS검측양성52례(100.0％),연합검측양성52례(100.0％).치료반년후,52례신경매독환자복사뇌척액TRUST、TPPA급FTA-ABS,TRUST전음솔위35.5％ (11/31),적도하강솔71.2％(37/52),적도＜1:4,TPPA급HTA-ABS균양성;복사혈청TRUST、TPPA급FTA-ABS,혈청TRUST전음솔위7.7％ (4/52),적도하강솔51.9％ (27/52),적도＜1:16,TPPA급FTA-ABS균양성;뇌척액TRUST전음솔명현고우혈청TRUST전음솔,차이유통계학의의(P＜0.05).결론 뇌척액TRUST가작위매독료효관찰적검측방법.FFA-ABS작위학진시험유일정우세,응연합TPPA작위신경매독적학진표준,실험실대우뇌척액매독적사사진단환응해이TPPA위주,연합TRUST작위료효관찰지표,연합FTA-ABS작위매독학진실험지표.
Objective To explore the value of three kinds of methodology for fluid examination in detecting syphilis.Methods Totally 483 patients with suspected syphilis underwent serum and cerebrospinal fluid examination by using toluidine red unheated serum test (TRUST), treponema pallidum particle agglutination (TPPA) and fluorescence treponemal antibody absorption (FTA-ABS).Patients with positive syphilis serology received regular treatment and underwent reexamination 6 months after treatment.The sensitivity and specificity of single use and combined use of different methods were compared.Results In 483 patients, 52 cases were neurosyphilis, 6 cases were congenital syphilis, 31 cases were latent syphilis, 36 cases were primary syphilis,149 cases were secondary syphilis, 98 cases were tertiary syphilis, 111 cases were non syphilis patients.For 431 cases except neurosyphilis, taking clinical diagnosis as gold standard, the sensitivity and specificity of serum TRUST, TPPA, FTA-ABS and combined detection were 84.4％ and94.6％ , 100.0％ and 99.1％, 100.0％ and 99.1％, 100.0％ and 100.0％.In 52 patients with neurosyphilis, the positive rates of TRUST, TPPA, FTA-ABS in cerebrospinal and combined detection were 59.6％ (31/52) , 100.0％ (52/52), 100.0％ (52/52) , 100.0％ (52/52).In 52 cases of neurosyphilis, 6 months after treatment, the negative conversion rate of TRUST in cerebrospinal fluid examination was 35.5％ (11/31) and the droop rate of titer was 71.2％ (37/52) with titer ＜1:4;the negative conversion rate of TRUST in serum examination was 7.7％ (4/52) and the droop rate of titer was 51.9％ (27/52) with titer ＜ 1 : 16;the negative conversion rates of TPPA and FTA-ABS in both cerebrospinal fluid and serum were 0.0％;the negative conversion rate of TRUST in cerebrospinal fluid was significantly higher than that in serum (P ＜ 0.05).Conclusions Cerebrospinal fluid examination by using TRUST can be used as a index to assess the curative effect in syphilis patients;TPPA combined with TRUST and FTA-ABS has betterdiagnostic ability for syphilis.
