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目的探讨在梅毒螺旋体(TP)感染的诊断中联合应用3种血清学检测方法的临床价值。方法用梅毒螺旋体抗体酶联免疫吸附试验(TP-ELISA)对临床标本进行梅毒筛查,阳性标本进一步行梅毒螺旋体明胶凝集试验(TPPA)和甲苯胺红不加热血清试验(TRUST)滴度检测。结果6483例血清标本行TP-ELISA筛查,检出阳性342例,其中TPPA法检测结果阳性313例,阳性检出率为91.5%(313/342);TRUST滴度在1∶2以上的265例,TPPA确证264例为阳性;TRUST滴度阴性77例,TPPA确证阳性49例,29例TP-ELISA阳性而TPPA阴性的标本TRUST滴度(<1∶2)阴性为28例。结论TP-ELISA法敏感性较高,操作方便,易自动化,可取代TRUST作为梅毒的常规筛查,但存在假阳性(8.2%)问题,尤其以60岁以上的老年人居多。TP-ELISA阳性的标本应进一步行TPPA确证,若TPPA阴性,2周后应再复查1次TPPA。TRUST已不适合梅毒的常规筛查,但其滴度可用于临床疗效观察。
Objective To investigate the clinical value of three serological tests in the diagnosis of Treponema pallidum (TP) infection. Methods Treponema pallidum antibody (TP-ELISA) was used to screen the syphilis in clinical samples. The positive samples were further tested by TPPA and TRUST titers. Results A total of 6483 serological samples were screened by TP-ELISA and 342 were positive, of which 313 were positive by TPPA assay and the positive rate was 91.5% (313/342). The titer of TRUST was above 1: 2 at 265 In the case of TPPA, 264 cases were positive; TRUST titer was negative in 77 cases, TPPA confirmed positive in 49 cases, 29 cases TP-ELISA positive in TPPA negative specimens TRUST titer (<1: 2) was negative in 28 cases. Conclusion The TP-ELISA method is sensitive, easy to operate, and easy to operate. It can replace TRUST as a routine screening for syphilis, but there is a false positive (8.2%) problem, especially for the elderly over 60 years of age. TP-ELISA-positive specimens should be further verified by TPPA. If TPPA is negative, TPPA should be re-examined after 2 weeks. TRUST is not suitable for routine screening of syphilis, but its titer can be used for clinical efficacy.