星云棋牌官网下载

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                          梅毒不同血清学检验方法的检测效能比较

                          时间:2019-03-21 来源:中国实验诊断学 作者:肖霞,滕春燕,马慧,宋 本文字数:5851字

                            摘    要:星云棋牌官网下载 目的 针对3种梅毒螺旋体血清学检验方法在临床应用进行分析。方法 患者标本首先进行梅毒螺旋体抗体酶联免疫吸附试验(TP-ELISA)检测,其中336例阳性患者再进行梅毒螺旋体明胶颗粒凝集实验(TPPA)、快速血浆反应素环状卡片实验(RPR)两种血清学检测。临床上明确诊断为梅毒的238例患者作为研究组,同期来我院就诊的150例健康体检者作为对照组,统计检测结果进行分析。结果 随着TP-ELISA试验的S/CO值的升高,TPELISA与TPPA检测结果的符合率随之升高。TPPA敏感度与特异度分别为97.47%、99.16%;ELISA分别为98.32%、98.00%;RPR分别为78.57%、94.00%。RPR对于早期与潜伏期梅毒的实验室检测阳性检出率明显低于TPPA、ELISA(P<0.05),而三种方法对晚期梅毒实验室检测阳性检出率未见明显差异(P>0.05)。结论 TPPA与ELISA方法检验梅毒螺旋体敏感度和特异度均较好,是良好的血清学检测方法适用于筛查和确诊,RPR适用于判断梅毒疗效及观察病情进程。TPPA或ELISA联合RPR实验可作为各期梅毒检测的可靠方法。

                            关键词: 梅毒螺旋体; 酶联免疫吸附法(ELISA); 明胶颗粒凝集法(TPPA); 快速血浆反应素环状卡片实验(RPR); 敏感度; 特异度;

                            Abstract:星云棋牌官网下载 Objective To explore the clinical application value of three serological methods for Treponema pallidum.Methods All samples were tested by TP-ELISA titer.If TP-ELISA was positive,TPPA was used to confirm the TPELISA.Among them,336 positive patients were treated with gelatin particle agglutination(TPPA)and RPR two serological tests,238 syphilis patients in outpatient and inpatient treatment of Dermatology and Venereology Department of our hospital were taken as study group,150 non-syphilis patients in our hospital were taken as control group during the same period.All subjects were collected venous blood for three serological tests:enzyme-linked immunosorbent assay(ELISA),gelatin particle agglutination assay(TPPA),rapid plasma reactin assay(RPR).Results TPPA sensitivity and specificity were 97.47% and 99.16%,ELISA 98.32% and 98.00%,RPR 78.57% and 94.00%,respectively.The positive coincidence rate of ELISA and TPPA was 99.6%.The positive rate of RPR for primary,secondary and latent syphilis was significantly lower than that of TPPA and ELISA(P<0.05),but there was no significant difference among the three methods(P>0.05).Conclusion TPPA and ELISA are good serological diagnostic methods for Treponema pallidum.TRUST is suitable for judging the efficacy of syphilis and observing the course of the disease.TPPA or ELISA combined with RPR test can be used as a reliable method for syphilis screening in different stages.

                            Keyword:星云棋牌官网下载 Treponema pallidum; Enzyme-linked immunosorbent assay(ELISA); Gelatin particle agglutination as-say(TPPA); Rapid plasma reactin assay(RPR); Sensitivity; Specificity; Positive coincidence rate;

                            MEIDUSHIYIZHONGYOUMEIDULUOXUANTIGANRANRENTICHANSHENGDEMANXINGCHUANRANXINGJIBING,ZHUYAOTONGGUOZHANMOJIECHUJINXINGCHUANBO,YEKEMUYINGCHUIZHICHUANBO。GAIBINGLINCHUANGBIAOXIANJIAOWEIFUZA。BINGCHENGFENWEISANQI,YIQI、ERQIYOUCHENGWEIZAOQIMEIDU,CHUANRANXINGQIANGPOHUAIXINGXIAO,SANQIMEIDUYOUCHENGWEIWANQIMEIDU,CHUANRANXINGRUODANSHIPOHUAIXINGJIAOQIANG,WEIDEDAOJISHIZHILIAOKEZAOCHENGRENTIDUOQIGUANSHOULEI,DUOXITONGSUNHAI,GONGNENGSHICHANG,RUXINXUEGUANMEIDU、GUMEIDUHESHENJINGMEIDUDENG,SHENZHIWEIJISHENGMING[1]。MUQIAN,YOUYUHESUANKUOZENGJISHUSHANGWEIGUANGFANYINGYONGYULINCHUANG,GUXUEQINGXUEJIANCERENGRANSHISHIYANSHIJIANCEMEIDULUOXUANTIGANRANZUICHANGYONGDEFANGFA[2]。RENTIGANRANMEIDULUOXUANTIHOUCHANSHENGLIANGZHONGKANGTI[3],YIZHONGZHENDUIMEIDULUOXUANTIDETEYIXINGKANGTI,ZAIMEIDUGANRANYUE2ZHOUZUOYOUJIKECHANSHENG,CILEIXUEQINGKANGTIJIANCELINCHUANGTONGCHANGSHIYONGMEIDULUOXUANTIMINGJIAOKELININGJISHIYAN(TPPA),MEILIANMIANYIXIFUSHIYAN(ELISA)、MEIDULUOXUANTIHUAXUEFAGUANGMIANYIFENXI(CLIA)JIANCE;LINGYIZHONGWEIZHENDUILEIZHIZHILEIWUZHIDEFEITEYIXINGKANGTI,TONGCHANGJIAOTEYIXINGKANGTICHUXIANWAN2-3ZHOU,LINCHUANGKEXUANYONGKUAISUXUEJIANGFANYINGSUHUANXINGKAPIANSHIYAN(RPR)、JIABENANHONGBUJIAREXUEQINGSHIYAN(TRUST)DENGFANGFAJINXINGJIANCE[4]。BENYANJIUCAIYONGMEIDULUOXUANTIKANGTIMEILIANMIANYIXIFUSHIYAN(TP-ELISA)、MEIDULUOXUANTIMINGJIAOKELININGJISHIYAN(TPPA)、KUAISUXUEJIANGFANYINGSUHUANXINGKAPIANSHIYAN(RPR)FENBIEJIANCEMEIDUHUANZHEXUEQING,PINGJIABUTONGXUEQINGXUEJIANYANFANGFADEJIANCEXIAONENG,JUTICAOZUORUXIA。

                            1、 资料与方法

                            1.1 、一般资料

                            搜集2019年1月-2019年3月我院门诊及住院的10273例患者标本进行梅毒抗体酶联免疫吸附试验(TP-ELISA),患者就诊于不同科室,所患基础疾病不同,其中男性5169名,女性5104名,年龄分布0-97岁,阳性结果再分别进行TPPA,RPR检测,统计结果。将其中经临床诊断为梅毒的238例患者作为研究组,临床诊断及分期标准参照卫生部《中华人民共和国卫生行业标准梅毒诊断标准WS273-2018》。其中男143例,女95例,年龄19-82岁,梅毒一期106例,二期59例,三期16例;潜伏期57例。选取健康体检者150例作为对照组,其中男83例,女67例,年龄17-85岁。所有检测标本均为空腹采集的静脉血血清。
                           

                          梅毒不同血清学检验方法的检测效能比较
                           

                            1.2、 方法

                            1.2.1 、仪器和试剂

                            ZHUYAOSHIJIXUANYONGZHUHAILIZHUSHIJIGUFENYOUXIANGONGSIELISASHIJIHE、RIBENFUSHIRUIBIOUZHUSHIHUISHEMEIDULUOXUANTIZHENDUANSHIJIHE(MINGJIAOKELININGJIFA)、SHANGHAIKEHUASHENGWUJISHUYOUXIANGONGSIRPRSHIJIHE;YIQIXUANYONGAIDEKANGELISA600QUANZIDONGMEIMIANFENXIYI。

                            1.2.2、 检验方法

                            YUQINGCHENKONGFUZHUANGTAIXIACAIJINGMAIXUE3ml,LIXINFENLIXUEQING(4 000r/min,6min)。YANGEANZHAOXIANGYINGSHUOMINGSHUZHONGDEFANGFAJINXINGCAOZUO,SHOUXIANJINXINGTP-ELISAJIANCE,JIANCEJIEGUOS/CO≥1DEBIAOBEN,ZAIFENBIEJINXINGTPPA、RPRJIANCE,JUTIFANGFARUXIA:(1)ELISAFA:YINGYONGAIDEKANGQUANZIDONGMEIMIANFENXIYIJINXINGCAOZUO,CAOZUOGUOCHENGYANGEANZHAOSHIJIHESHUOMINGSHUSHEDINGCHENGXU,FANYINGWANCHENGHOUTONGGUOMEIBIAOYIJIANCEXIGUANGDU,XIGUANGDUOD>0.105JI(S/COZHI>1)PANDINGWEIYANGXING。(2)TPPAFA:JIANG100μlXUEQINGXISHIYEJIAZHIWEIKONGBANDI1KONGNEI,QIHOU3KONGGEJIARU25μl。YONGWEILIANGYIYEQIQUYANGPIN25μlZHIDI1KONGZHONG,HUNYUNHOUXICHU25μlZHIDI2KONG,TONGYANGFANGSHIXISHIZHIDI4KONG,ZAIDI4KONGHUNYUNHOUQIQU25μl。XISHIHOUDI3KONG、DI4KONGXISHIBEISHUFENBIEWEI1∶20、1∶40,SHIYONGWEILIANGJIAYANGQIZAIDI3KONGZHONGJIARU25μlWEIZHIMINKELI,DI4KONGZHONGJIARU25μlZHIMINKELI,CISHIYANGBENZUIZHONGXISHIBEISHUWEI1∶40、1∶80,HUNYUNHOUSHIWENSHUIPINGFANGZHI2hHOUGUANCHAJIEGUO。YANGXINGPANDINGBIAOZHUN:DI4KONGFANYINGCHANSHENGHUANZHUANGFENSANLIZIPANDINGWEIYANGXING。(3)RPRFA:XUEQINGJINXINGBEIBIXISHIZHI1∶2、1∶4、1∶8、1∶16SHIYANKABIAOHAO1-4;YICICONGQUAN4-1JIANGXISHIHOUBIAOBENTUBUYUZHENGGEQUANNEI;JIARU1DIKANGYUAN(YUE17μl/DI);JIANGSHIYANKAZHIYUSHUIPINGXUANZHUANYI,100±2r/minXUANZHUAN8FENZHONG;QUCHUSHIYANKAZAILIANGGUANGXIAROUYANGUANCHAJIEGUO。RUOBIAOBENCHUXIANHEISEKUAIZHUANGCHENDIAN,JIPANDINGWEIYANGXING,YANGXINGJIEGUOYINGBAOGAOQIXISHIBEISHU,JIWEIQIDIDU。SANZHONGFANGFAJIANCEWANBI,JIEHELINCHUANGBIAOXIAN,XUANQUYOUMINGQUEZHENDUANDEBIAOBENZUOWEIYANJIUZU,YUDUIZHAOZUJINXINGBIJIAO,ZHENDUISANZHONGJIANCEFANGFADEMINGANXINGHETEYIXINGJINXINGBIJIAO。

                            1.3、 统计学方法

                          星云棋牌官网下载   CAIYONGSPSS19.0TONGJIXUERUANJIANDUIBENYANJIUSHUJUJINXINGFENXICHULI,JISHUZILIAOCAIYONG(n,%)BIAOSHI,SHUJUBIJIAOXINGχ2JIANYAN,SHEZHIJIANYANSHUIZHUNα=0.05,YIP<0.05WEICHAYIJUYOUTONGJIXUEYIYI。

                            2、 结果

                            2.1 、10273例患者标本进行梅毒抗体酶联免疫吸附试验(TP-ELISA)的一般情况

                          星云棋牌官网下载   10273LIHUANZHEWEIWOYUANMENZHENJIZHUYUANHUANZHE,JIUZHENYUBUTONGKESHI,SUOHUANJICHUJIBINGBUTONG,NANXING5169MING,NVXING5104MING,QIZHONGTP-ELISAJIANCEYANGXINGDEHUANZHEGONG336LI,NANXING171LI,NVXING165LI,YANGXINGLVYUE3%,NIANLINGFENBUJIANBIAO1。

                            表1 TP-ELISA阳性患者年龄分布
                          表1 TP-ELISA阳性患者年龄分布

                            2.2、 336例TP-ELISA阳性,3例TP-ELISA弱阳

                            XINGGONGJI339LIHUANZHEDETPPAJIEGUOYUTP-ELISAJIEGUOFUHELVSUITP-ELISA S/COZHIDESHENGGAOCHENGXIANTONGBUSHENGGAOQUSHI,JIANBIAO2。

                            表2 TP-ELISA TPPA检测结果的符合率
                          表2 TP-ELISA TPPA检测结果的符合率

                            2.3、三种检测方法敏感度、特异度

                          星云棋牌官网下载   FENBIETONGJI238LIMEIDUHUANZHEYU150LIFEIMEIDUHUANZHEDESANZHONGJIANCEFANGFAJIEGUODEZHI,TPPAFAMINGANDUYUTEYIDUFENBIEWEI97.47%、99.33%;ELISAFAFENBIEWEI98.32%、98.00%;RPRFAFENBIEWEI78.57%、94.00%。JIANBIAO3。

                            2.4、三种检测方法在不同分期梅毒患者的阳性检出率

                          星云棋牌官网下载   DUIYUYIQI、ERQIYUQIANFUQIMEIDU,RPRFANGFAJIANCEDEYANGXINGLVMINGXIANDIYUTPPA、ELISAFA(P<0.05),ERDUIYUSANQIMEIDU,SANZHONGFANGFAJIANCEDEYANGXINGLVWEIYOUMINGXIANCHAYI(P>0.05)。JIANBIAO3。

                            表3 三种梅毒螺旋体检测方法敏感度和特异度
                          表3 三种梅毒螺旋体检测方法敏感度和特异度

                            表4 不同分期梅毒患者的阳性检出率
                          表4 不同分期梅毒患者的阳性检出率

                            3、 讨论

                          星云棋牌官网下载   MEIDUZAIWOGUOCHUANRANBINGFANGZHIFAZHONGBEILIEWEIYILEIFANGZHIBINGZHONG,JINNIANLAIZAIWOGUOHUANBINGLVCHIXUPANSHENG,GAIBINGZAOQIZHUYAOQINFANPIFUHEZHANMO,WANQIHAIKEQINFANXINZANGXUEGUANXITONGJIZHONGSHUSHENJINGXITONG,ZAOCHENGZHONGYAOQIGUANJIZUZHIYONGJIUXINGSUNHAI[5]。MEIDUBINGCHENGJIAOZHANG,ZAOQIFANGZHIKONGZHIBINGCHENGJINZHANSHIZHILIAOGUANJIAN,MUQIANLINCHUANGSHANGYIJUHUANZHEBINGSHI、XUEQINGXUEJIANCEJIEGUO、LINCHUANGBIAOXIANJINXINGZONGHEZHENDUAN,GUTIGAOSHIYANSHIXUEQINGXUEJIANCEMEIDULUOXUANTIDELINGMINDU,XUANZEHESHIDEJIANCEFANGFA,DUIYUMINGQUEZHENDUAN、JINZAOZHILIAOMEIDUJUYOUZHONGYAOYIYI。MEIDULUOXUANTIGANRANRENTI,KECHANSHENGMEIDULUOXUANTIFEITEYIXING(KANGLEIZHIZHIKANGTI)YUTEYIXINGLIANGZHONGBUTONGDEKANGTILEIXING,LIANGZHONGKANGTIDEJIANCEDUIYUMEIDUHUANZHEDESHAIJIANJIQUERENJUYOUBUTONGDELINCHUANGYIYI,FEITEYIXINGKANGTIYOUCHENGWEIFANYINGSU,ZAIMEIDULUOXUANTIGANRAN3-4ZHOUCHANSHENG,BANSUIZHEYOUXIAOZHILIAOERXIAOSHI,HOUZHEWEITEYIXINGKANGTI,ZAIGANRAN2ZHOUZUOYOUCHANSHENG,ZHEIZHONGIgGLEIXINGKANGTIYIDANCHANSHENG,BIANHUIZHONGSHENXIEDAI,BUHUISUIZHEYOUXIAOZHILIAOERXIAOSHI。LIANGZHONGKANGTIZAIJIBINGDEZHENDUAN,LIAOXIAOGUANCHA,FUFAPANDUANFANGMIANJUYOUBUTONGDEYIYI。BENYANJIUZHONGSUOXUANTPPA、ELISAJIANCEFANGFAZHENDUITEYIXINGKANGTI、RPRJIANCEFANGFAZEZHENDUIFEITEYIXINGKANGTIJINXINGJIANCE,TANTAOLESANZHONGJIANCEFANGFADEFUHELVJILINCHUANGYINGYONGJIAZHI。

                            BENCIYANJIUDUIXIANGWEIWOYUANMENZHENJIZHUYUANHUANZHEGONG10273LI,YINWEIELISAFANGFACAOZUOJIANDAN,KEZUOWEIGAOTONGLIANGDEJIANCEXIANGMUJINXINGZIDONGHUAYIQICAOZUO,QIEMINGANXINGJIAOHAO,SUOYIBEIZUOWEISHOUXUANDESHAICHAFANGFA。JIANCEJIEGUOJINGGUOPANDUHOU,GONG336LIPANDUANYANGXING,YANGXINGLVYUE3%,QIZHONGYOUYUCANYUJIANCEDEHUANZHENIANLINGBUTONG,SUOHUANJICHUJIBINGBUTONG,CUNZAIYIDINGYINQITP-ELISAFASHENGWUXUEJIAYANGXINGDEYINSU。TPPAFAJIANCESHICAIYONGMEIDULUOXUANTIDUZHUZUOWEIKANGYUANBAOBEIZAININGJIAOKELISHANG,YUMEIDUXUEQINGYANGBENZHONGDETEYIXINGKANGTIJIEHECHANSHENGKELININGJI。SHIMUQIANJIAOQUANWEIDEMEIDUQUEZHENSHIYAN[6]FANGFA,SUOYI,WOMENJIANGELISAJIANCEPANDUANYANGXINGDE336FENJICHUYUJIANCEHUIQU(S/ODZHI0.9-1)DE3FENBIAOBENGONG339FENYOUJINXINGLETPPAFAJIANCE,TONGJIELISAYUTPPAJIANCEYANGXINGFUHELV,FAXIANLIANGZHEFUHELVSUITP-ELISAJIANCES/ODZHISHENGGAOERSHENGGAO,ZAITP-ELISAFACEDINGZHIWEI1-6QUJIANSHI,LIANGZHEFUHELVWEIJINWEI43.8%(39/89)。YINCIDUILINCHUANGYONGELISAFAJIANCEDAO(S/CO)DIZHIYANGBENSHI,YONGTPPAFAKAIZHANQUEZHENGSHIYANYOUWEIBIYAO,BINGYINGJIEHELINCHUANGBIAOXIANJIAYIPANDUAN,YIJIANSHAOYINELISAFAJIAYANGXINGFASHENGERYINQIDEWUZHEN。

                          星云棋牌官网下载   336LITP-ELISAYANGXINGDEHUANZHEZHONG,JINGLINCHUANGQUEZHENDEMEIDUHUANZHEWEI228LI,WOMENYOUXUANQULE150LIFEIMEIDUHUANZHEJINXINGTP-ELISAFA,TPPAFA,RPRFASANZHONGFANGFATONGSHIJIANCE,BINGDUIBISANZHONGFANGFADEYINGYONGJIAZHI。JIANCEJIEGUOXIANSHI:ZAIMINGANXINGFANGMIAN,JIANCEMEIDUTEYIXINGKANGTIDETP-PAFAZAIYIQIMEIDUJIERQIMEIDUDEJIANCEMINGANXINGLVEDIYUTP-ELISAFAJIANCE,DANBUJUTONGJIXUEYIYI;RPRFAMINGANXINGZUIDI。RPRFAJIANCEDEWEIMEIDUFEITEYIXINGKANGTI,JILEIZHIZHILEIKANGTI,QICHUXIANJIAOTEYIXINGKANGTIWAN,YINCIQIZAIYIQIMEIDUDEMINGANXINGYAODIYUTPPAHETP-ELISAFA,LEIZHIZHILEIKANGTIHUISUIZHEMEIDUYOUXIAOZHILIAOERZHUJIANXIAOSHI,ZHEIYESHIYINQIRPRJIANCEDEJIANCHULVZAIGEQIMEIDUJUNDIYUTP-PAJITP-ELISADEYUANYINZHIYI;ZAITEYIXINGFANGMIAN,TP-PAFAZAISANZHONGJIANCEFANGFAZHONGTEYIXINGZUIGAO,RPRFATEYIXINGZUIDI。JINGUANRUCI,TPPAFAHETP-ELISAFARENGCUNZAIYUE1%DEJIAYANGXINGLV,RULAONIANHUANZHE、ZHONGLIUHUANZHE、ZISHENMIANYIXINGJIBINGHUANZHE、YUNFU、ZHANGQIXIDUHUANZHE,JIBUFENHEBINGQITALUOXUANTIGANRANDEHUANZHEJUNHUIYINQITEYIXINGKANGTIJIANCEDESHENGWUXUEJIAYANGXINGFANYING,ERQIEMEIDUTEYIXINGKANGTIDEYANGXINGJIEGUOWUFAQUFENHUANZHECHUYUSHIFABINGQIHAISHIJIWANGGANRAN,YINCIBUNENGGOUDANCHUNYIJUJIANCEJIEGUOJINXINGZHENDUAN[7]MEIDU,XUJIEHELINCHUANGZHENGZHUANGJINXINGPANDUAN,RPRFAJIANCEDEKANGTIBUJUYOUTEYIXING,XUDUOJIBINGRUJIEHEBING、MAFENGDENGZAIJIBINGGUOCHENGZHONGJUNCHANSHENGLEISIKANGTI,GURPRFAJIAYANGXINGLVJIAOGAO。LINCHUANGSHANG,GAIFACHANGYONGYUTONGGUOGUANCHADIDUDEBIANHUALAIPANDUANMEIDULIAOXIAOHUOGUANCHABINGCHENG[11]。

                            MEIDUXUEQINGXUEJIANYANZAILINCHUANGZHENDUANZHONGZHANJUZHONGYAODIWEI,TPPA、ELISAMINGANDUYUTEYIDUJUNJIAOHAO,ZAIGEQIMEIDUZHENDUANZHONGJUNJUYOULIANGHAODEWENDINGXING,SHIJIAOWEILIXIANGDEXUEQINGXUEJIANCEFANGFA。RPRFALINGMINDUHETEYIDUSUILVEDIYUQIANLIANGZHE,DANZUOWEIMEIDULIAOXIAOPINGJIAFANGFACHENGBENDI,CAOZUOJIANDAN,BEIGUANGFANYINGYONG。TPPAHUOELISAFALIANHERPRKEZUOWEIMEIDUSHAICHADEKEKAOFANGFA[12,13],ZAITIGAOYANGXINGJIANCHULVTONGSHIJIANSHAOJIAYINXINGLV,BINGZUOWEIGUANCHAMEIDULIAOXIAOJIBINGCHENGDEZHONGYAOZHIBIAO,ZHIDAOHUANZHEDEDAOJISHIYOUXIAODEZHENZHI。DUIYUMEIDUJIANCHUYANGXINGHUANZHE,LINCHUANGYISHIHAIYINGJIEHEBINGSHI、ZHENGZHUANG、TIZHENGDENGZONGHEFENXI,YITIGAOQUEZHENLV[14]。

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                            论文来源参考:肖霞,滕春燕,马慧,宋丹丹,李艳蕾,王欣.三种梅毒螺旋体血清学检验方法的临床应用分析[J].中国实验诊断学,2020,24(02):286-289.
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