Abstract:Objective To investigate the value of different combinations of serological tests in the diagnosis of syphilis. Methods The serum of 20 325 patients visited Beijing Ditan Hospital from September 2016 to August 2017 were collected. Three methods including toluene red unheated serum test (TRUST), treponema pallidum gelatin agglutination test (TPPA) and fluorescent treponema pallidum antibody absorption test (FTA) were used to test the syphilis antibodies in the serum sample. Results Among the 20 325 patients, 4480 were diagnosed with treponema pallidum (TP) infection and among these patients with TPPA-positive, 3342 cases were positive for TRUST, accounted for 74.6%; 1138 cases were negative for TRUST, accounted for 25.4%. Among 3342 cases of TPPA-positive and TP-positive patients, 979 cases were positive for FTA-ABS-IgM, accounted for 29.3%. Among 1138 cases of TPPA-positive and TRUST-negative patients, 12 cases were positive for FTA-ABS-IgM, accounted for 1.05%. The positive rate of IgM antibody in 979 patients with syphilis was logarithmically correlated with different dilutions of the TRUST (R2 = 0.9351). Conclusion For laboratories that carried out syphilis serological tests, TPPA and TRUST should be carried out simultaneously. FTA-ABS-IgM was an effective complement for two other methods with TRUST-negative and TRUST persistent positive after treatment.
[1] Hesketh T,Zhu WX,Zhou XD. Syphilis and social up-heaval in China [J]. N Engl J Med,2010,363(11):1088-1089.
[2] Cabe A,Rollin B,Pierre-Francois S,et al. Reemergence of syphilis in Martinique,2001-2008 [J]. Emerg Infect Dis,2010,16(1):106-109.
[3] Casal CA,Silva MO,Costa IB. Molecular detection of Treponema pallidum sp.pallidum in bloodsamples of VDRL-seroreactive womenwith lethal pregnancy outcomes:a retrospective observational studyin northern Brazil [J]. Rev Soc Bras Med Trop,2011,44(4):451-456.
[4] 卫生部.WS273-2007 梅毒诊断标准[S].
[5] Aktas G,Young H,Moyes A,et al. Evaluation of the fluorescent treponemal antibody absorption test for Detection of antibodies(immunoglobulins G and M)to Treponema pallidum in serologic diagnosis of syphilis [J]. Int J STD AIDS,2007,18(4):255-260.
[6] 黄进梅,郑和平.梅毒螺旋体特异性IgM抗体检测的临床评价[J].国际检验医学杂志,2006,27(2):108-110.
[7] 李武艺.不同检测方法在梅毒血清学检测中的应用效果[J].临床合理用药,2016,9(5c):161-162.
[8] Ebel A,Vanneste L,Cardinaels M,et al. Validation of the INNO‐LIA syphilis kit as confirmatory assay for treponema pallidumantibodies [J]. J Clin Microbiol,2000,38(1):215-219.
[9] 武建国.梅毒实验室诊断与相关问题[J].临床检验杂志,2006,24(4):316-320.
[10] 柯吴坚,杨斌.2015美国疾病控制中心性传播疾病(梅毒)治疗指南[J].皮肤性病诊疗学杂志,2015,22(4):343-344.
[11] 冯凌思,余健全,陈航华,等.梅毒螺旋体的检测方法和应用探讨[J].医药前言,2016,6(17):126-127.
[12] 施辛.已治早期显性梅毒患者血清RPR试验和梅毒螺旋体IgM抗体检查联合随访[J].中华皮肤科杂志,2002, 35(4):290-292.
[13] 李布荣,贺军涛,张毅,等.梅毒螺旋体IgM抗体检测的临床意义[J].第四军医大学学报,2007,28(16):1494-1496.
[14] 文海燕,张华荣,陈正明,等.梅毒检测方法的研究进展[J].中国皮肤性病学杂志,2012,26(4):354-357.
[15] Smith BC,Simpson Y,Morshed MG,et al. New proteins for a new perspective on syphilis diagnosis [J]. J Clin Microbi,2013,51(1):105-111.
[16] 何玉清,邓建华,杨日东,等.隐性梅毒患者血清抗梅毒螺旋体抗体的检测及其临床意义[J].新医学,2004,35(3):165-166.
[17] 何立娟,徐飞,袁慧.三种方法对梅毒的临床诊断价值[J].中国医药,2015,10(12):1856-1858.
[18] 李军,王林娜,郑和义.梅毒血清IgM抗体与传染性的关系[J].中国皮肤性病学杂志,2012,178(7):28-30.
[19] 顾伟鸣,杨阳,吴磊.梅毒血清学试剂性能评估方案的优化及应用[J].检验医学,2014,29(11):1169-1174.
[20] Chua AC,Chen MI,Cavailler P,et al. Challenges of respondent driven sampling to assess sexual behaviour and estimate the prevalence of human immunodeficiency virus(HIV)and syphilis in men whohavesexwithmen(MSM)insingapore [J]. Ann Acad Med Singapore,2013,42(7):350-353.