化学发光法在梅毒实验诊断中的应用价值

目的:探讨化学发光法在梅毒实验诊断中的应用价值。方法:采用化学发光法、RPR法、TPPA法分别检测150例梅毒患者及125例非梅毒患者血清。结果:化学发光法、RPR法、TPPA法对150例梅毒血清标本和125例非梅毒血清标本对照组的敏感性分别为98.0%、75.3%和97.3%,特异性分别为98.3%、81.6%和97.5%。化学发光法、TPPA法敏感性和特异性明显高于RPR法,差异有统计学意义(P<0.05);化学发光法和TPPA法相比,敏感性和特异性差别不大,差异没有统计学意义(P>0.05);联合3种方法检测,梅毒诊断阳性率可提高到100%。结论:梅毒的化学发光检测法具有极高的敏感性和特异性,是一种自动化、定量检测方法,能够用于梅毒的准确诊断和疗效观察,与传统方法联检可防止误诊、漏诊,具有较大的临床应用价值。     

Serological diagnosis of syphilis: comparison of the Trep-Chek IgG enzyme immunoassay with other screening and confirmatory tests

The Trep-Chek IgG Enzyme Immunoassay (Trep-Chek IgG EIA) was evaluated with 604 serum specimens submitted for syphilis serology from patients across Canada against a battery of conventional syphilis serology tests, including the Rapid Plasma Reagin (RPR) test, the Venereal Disease Research Laboratory (VDRL) test, the Treponema pallidum passive particle agglutination (TP-PA) test, the fluorescent treponemal antibody absorption (FTA-ABS) test, and the newer confirmatory test, Innogenetics INNO-LIA. On the basis of a consensus result derived from these serologic tests, 34 specimens were found to be syphilis-positive (28 active and six past infections), and 570 were syphilis-negative (including 12 biological false positives). When the test results on this set of samples were compared to those obtained with the conventional tests RPR, VDRL, TP-PA, and FTA-ABS, the sensitivity and specificity of the Trep-Chek IgG EIA were found to be 85.3% and 95.6%, respectively. Without further evaluation, we do not recommend use of the Trep-Chek IgG EIA as a stand-alone test for either screening or confirmatory syphilis serology.     

Treponematosis: a possible case from the late prehistoric of North Carolina

The skeleton of an adult female exhibiting evidence of treponemal infection was recently recovered from the Hardin site in the piedmont region of North Carolina. Archaeological indicators suggest a late prehistoric affiliation. The skeleton is affected by a diffuse process resulting in surface changes, both destructive and appositional, node formation and shaft expansion, medullary encroachment and filling, cortical thickening, and fracture. There is both cranial and postcranial involvement. While treponemal infection is indicated, the atypical nature of the total pattern raises the possibility of multiple pathological processes operating simultaneously. The significance of this case is threefold. It provides information on the ability of prehistoric peoples to cope with disease. It reminds the paleopathologist of the dangers inherent in attempts at singular and specific diagnoses. It sheds new light on the epidemiology of the treponemal diseases.     

梅毒血清抗体检测与临床的关系分析

目的探讨梅毒血清抗体检测与临床的相关性。方法对我院10710例进行梅毒血清抗体检测者,根据性别、年龄的不同比较它们之间的关系,并进行分析结果判断与临床的相关性。结果不同性别患者梅毒血清抗体检测无显著性差异（P〉0.05）,而不同年龄患者梅毒血清抗体检测有显著性差异（P〈0.01）。结论由于患者自身原因、试剂原因及HIV感染等因素,造成梅毒血清抗体试验有一定的假阳性和假阴性,因此对梅毒血清抗体试验结果应结合病史及临床情况进行综合分析判断。     

Evidence for the presence of lipopolysaccharide in Treponema phagedenis (biotype Reiterii) but not in Treponema pallidum (Nichols)

Abstract Immunoblotting profiles of whole or protease-K-digested organisms with homologous antisera demonstrated the presence of a characteristic ladder pattern of smooth LPS in Treponema phagedenis . Periodic acid silver staining of SDS-PAGE gels confirmed these findings. However, when heterologous or homologous serum was reacted with Treponema pallidum , no such pattern or cross-reactions were observed. The significance of apparent absence of LPS in T. pallidum is discussed.     

Histological identification of syphilis in pre-Columbian England

Microscopic analyses served to complement the macroscopic identification of venereal syphilis in two of four pre-Columbian skeletons from the site Hull Magistrates Court in England. Diagnosis was based on parameters presented by Schultz ([1994] Origin of Syphilis in Europe, Toulon: Centre Archaeologique du Var, p. 63-67; [2001] Yrbk. Phys. Anthropol. 44:106-147; [2003] Identification of Pathological Conditions in Human Remains, New York: Academic Press, p. 73-109), which characterized venereal syphilis at a histological level. Observation of the microarchitecture of these samples allowed a more comprehensive approach to identification of the disease (processes). In most samples, Polsters and Grenzstreifen (or remnants of such structures) could be identified, suggesting the presence of a chronic, inflammatory disease such as venereal syphilis. Sinous lacunae were also observed in all histological samples, pointing to lytic activity (osteitis). The combination of both proliferative and destructive processes is pathognomonic for syphilis, and histological analyses provided a more accurate diagnosis of this infectious disease in these four individuals. As a result, the histological evidence suggests that venereal syphilis was present in England prior to 1492. This secondary form of evidence supports the macroscopic identification of the disease, and shows the power of a multimethodological approach to paleopathological diagnoses.     

Regional, social, and evolutionary perspectives on treponemal infection in the Southeastern United States

The origin and geographic distribution of syphilis, a form of treponemal infection, have long been regarded as among the most important medical riddles of prehistoric and historic disease evolution. In this study, we expand on previous discussions of the origin, evolution, and relationship of treponemal infections as they occur in the prehistoric southeastern United States. Individuals from 25 skeletal series (n = 2,410 individuals) were examined for cranial and dental lesions characteristic of treponemal infection. They lived between the Archaic period (8000-1000 BC) and protohistoric period (AD 1500-1600), and in physiographic zones from the coast to the mountains of Alabama, Florida, North Carolina, and Tennessee. Radial cranial scars were found for 47 individuals, but none of the four cases of dental lesions could be attributed to congenital syphilis. Differences in frequency of cranial lesions by region were minimal, with the least number of cases found for the mountains, but the frequency of positive cases tended to increase through time. It is suggested that increasing population density and changing behaviors, rather than novel strains of the treponemal pathogen, are responsible for the chronological increase in the frequency of positive cases.     

Isotopic tracing of the impact of mobility on infectious disease: The origin of people with treponematosis buried in hull,England, in the late medieval period

Treponematosis has been one of the most studied and debated infectious diseases in paleopathology, particularly from the standpoint of its origin, evolution, and transmission. This study links evidence for treponematosis in skeletons from the 14th–16th century AD cemetery of the Augustinian friary of Hull Magistrates Court, England, with data from stable isotope analysis to test the hypothesis that the people with treponemal disease buried at this site were not locally born and raised. The objective is to explore the potential of using stable isotope data to track the place of origin and extent of mobility of individuals with an infectious disease. Dental enamel samples of 12 skeletons were selected for strontium (⁸⁷Sr/⁸⁶Sr ratio) and oxygen (δ¹⁸O) stable isotope analysis based on the presence (six ‐ diseased) or absence (six ‐ controls) of bone changes associated with treponemal disease. The oxygen isotope ratios of all but three individuals (1047, 1121, 823) overlapped at two standard deviations with the inferred local precipitation range, and only one individual (1216) had a strontium isotope ratio outside the regional range. Two of the four had probable/possible treponemal bone changes. Those with treponemal bone changes were not demonstrably more likely to be migrants than those without such lesions. However, because of extensive documentary evidence for trade with the Baltic Sea area, and for merchants from towns such as Stralsund, Danzig and Elbing being in Hull, it is very plausible that the four migrants came from the Baltic area or even southern Sweden. Am J Phys Anthropol, 2013. © 2012 Wiley Periodicals, Inc.     

梅毒检测技术研究进展

悔毒是由悔毒螺旋体引起的一种性传播疾病,传染性很强,目前已成为世界性的公共安全问题。、早发现早诊断对于悔毒的治疗极为重要．．梅毒的诊断主要依靠实验室检测。我们从病原体、抗体、基因等3个方面对近几年悔毒检测技术和方法进行了综述,论述了其基本原理、研究进展及各自的优缺点。     

梅毒患者外周血淋巴细胞亚群测定的意义

目的检测HIV阴性隐性梅毒患者外周血T淋巴细胞亚群及NK淋巴细胞的比例,并探讨其临床意义.方法应用流式细胞仪检测43例未经治疗的隐性梅毒患者和46例已经数疗程驱梅治疗但RPR持续阳性2年以上的隐性梅毒患者外周血T淋巴细胞亚群及NK淋巴细胞的比例,并与30例健康人群的检测结果相对照.结果1.未经治疗的隐性梅毒患者和已经治疗但RPR持续阳性2年以上的隐性梅毒CD3、CD4及NK淋巴细胞的比例分别与健康人群的检测结果相比,差异均无显著性(P＞0.05);未经治疗的隐性梅毒患者CD8淋巴细胞的比例明显高于对照组(P＜0.001);已经治疗但RPR持续阳性2年以上的隐性梅毒患者CD8淋巴细胞的比例高于对照组(P＜0.05);未经治疗的隐性梅毒患者CD4/CD8的比率明显低于对照组(P＜0.001),而已经治疗但RPR持续阳性2年以上的隐性梅毒患者CD4/CD8的比率与对照组相比差异无显著性(P＞0.05);2.未经治疗的隐性梅毒患者和已经治疗但RPR持续阳性2年以上的隐性梅毒患者的检测结果相比,CD3、CD4及NK淋巴细胞的比例及CD4/CD8的比率差异无显著性(P＞0.05);未经治疗梅毒患者CD8淋巴细胞比例高于已经治疗但RPR持续阳性2年以上的隐性梅毒患者(P＜0.05).结论未经治疗的隐性梅毒患者和已经治疗但RPR持续阳性2年以上的隐性梅毒患者均存在细胞免疫不平衡和免疫抑制,这种异常可降低机体抵抗和消除梅毒螺旋体感染的能力,并且可能是梅毒患者难于治愈,RPR持续阳性的主要原因.     

P53 Immunostaining As A Marker For Oral Cancer In Diagnostic Cytopathology-Preliminary Report

The expression of p53 in oral mucosal disorders is strongly associated with malignant disease. Smears from normal and malignant oral mucosa were investigated for the presence of p53 using CM1 polyclonal antibody against p53 protein. the expression of p53 in smears was compared with the expression of the marker in biopsies from these oral carcinomas. p53 was identified in eight smears from 12 biopsy positive oral cancers. It was not seen in smears from eight p53-negative oral cancers and 40 smears from normal oral mucosa. It is suggested that expression of p53 in smears from a clinically suspicious lesion may be of value in the diagnosis of oral carcinoma.     

Characterization of the serum requirement for macrophage-mediated killing of Treponema pallidum ssp. pallidum: Relationship to the development of opsonizing antibodies

Abstract Serum pools were collected from rabbits bled at various times after intra-testicular infection with Treponema pallidum ssp. pallidum . These were tested for their ability to opsonize T. pallidum and promote killing of the organisms by macrophages. Compared to normal sera, significant opsonization was first seen on day 10 of infection as measured by both ingestion ( P < 0.001) and macrophage-mediated killing ( P = 0.006); significant levels of functional antibodies persisted through 300 days of infection. Although opsonic activity peaked early in infection, antibodies that promoted optimal macrophage-mediated killing developed much later, suggesting that these two functions may represent activities of antibodies with differing specificities or affinities. The initial development of antibodies that augment both phagocytosis and killing corresponds with the in vivo clearance of treponemes from the primary site of infection. These observations support the hypothesis that macrophages are the major effector mechanism for elimination of T. pallidum during early syphilis infection.     

Diagnostic value of micro-CT in comparison with histology in the qualitative assessment of historical human skull bone pathologies

Cases of pathologically changed bone might constitute a diagnostic pitfall and frequently need histological methods to be etiologically properly evaluated. With micro‐computed tomography (μCT), a new epoch of 2D and 3D imaging has been launched. We evaluated the diagnostic investigation of this analytical method versus well established histological investigations of historical human bone. Pathological changes due to various etiologies (infectious, traumatic, endocrinological, neoplasia) observed in autopsy‐based macerated human skulls (Galler Collection, Natural History Museum Basel, Switzerland) were investigated by μCT and compared with histological thin ground sections using polarized light. Micro‐CT images visualize the architecture of the bone with high spatial resolution without preparation or destruction of the sample in the area to be sectioned. Changes in the bone surfaces as well as alterations of the diploë can be assessed. However, morphological patterns caused by reactive response, such as typical arrangements of collagen fibers, can only be visualized by the microscopic investigation of thin ground sections using polarized light. A great advantage of μCT is the high number of slices obtained so that spatial differences within the areas of the specimen become visible. Micro‐CT is a valuable tool for the diagnosis of vestiges of skull bone diseases. Its advantages over histology are the fast, automated image acquisition and the fact that the specimen is not completely destroyed. Only excision of the area to be scanned is necessary, if the specimen is too large to be scanned as a whole. Further, the 3D visualization of the micro‐architecture allows an easy orientation within the sample, for example, for the choice of the location of the histological slices. However, the need to differentiate woven from lamellar bone still makes histology an indispensable method. Am J Phys Anthropol, 2007. © 2007 Wiley‐Liss, Inc.     

一期梅毒实验室诊断差异性研究

目的通过梅毒螺旋体初筛试验、确认试验和鉴别诊断试验,探讨一期梅毒实验室诊断差异性,最大限度减少漏诊与误诊,为深入研发新型早期梅毒诊断试剂奠定基础。方法依据2000年中国卫生部防疫司颁布的性病诊断标准,临床筛选一期梅毒患者86例（研究组）和非梅毒患者100例（对照组）,对患者血清进行甲苯胺红不加热血清试验（TRUST）初筛和梅毒螺旋体明胶颗粒凝集试验（TPPA）确认。筛选临床体征、TRUST法和TPPA法三者结果有差异的患者进一步鉴别诊断,鉴别诊断主要应用荧光定量PCR（FQ-PCR）法、免疫PCR法与自身抗体检测等试验。结果初筛TRUST法灵敏度和特异性分别为62．8％、93．0％;确认TPPA法灵敏度与特异性分别为66．3％、100％。TRUST法和TPPA法两者结果差异占12．8％;临床体征诊断、TRUST法和TPPA法三者结果差异占41．9％。TPPA法与TRUST法两者均阴性的一期梅毒患者中,FQ-PCR阳性率达88．0％,免疫PCR阳性率占40．0％。TPPA法阳性、TRUST法阴性的一期梅毒患者免疫PCR法与TPPA法结果一致;TPPA法阴性、TRUST法阳性11例患者中结核抗体阳性2例,类风湿因子阳性3例与抗Sm抗体结果阳性6例。结论一期梅毒患者实验室诊断结果差异性较大,漏诊与误诊的比例较高,有待研发新型的诊断试剂和提高诊断水平。     

巢式PCR法在早期梅毒诊断中的应用评价

目的：评价巢式PCR（nPCR）法在早期梅毒诊断中的临床应用价值,以提高早期梅毒诊断的灵敏度和特异性。方法：选择2010年10月至2011年11月来我院就诊,经临床综合分析为一期梅毒的患者195例和同期就诊的120例非梅毒患者为研究对象,采用nPCR法对棉拭子标本和血液标本中梅毒螺旋体特异性基因tpp47进行扩增检测,所有标本同时做暗视野镜检和Tp—ELISA血清学检测。结果：nPCR法共检测出阳性标本176例,其灵敏度和特异性分别为90．3％和100％,明显高于暗视野镜检和Tp-ELISA法,差异有统计学意义。结论：nPCR法在早期梅毒诊断中具有较高灵敏度和特异性,可以作为暗视野镜检和血清学检测的补充试验。     

The impact of liquid-based oral cytology on the diagnosis of oral squamous dysplasia and carcinoma

OBJECTIVE: Even though diagnostic oral exfoliative cytology is a useful, economical and practical tool in the diagnosis of oral dysplasia and carcinoma, it is not yet extensively used. The results of conventional exfoliative and liquid-based diagnostic cytology in oral potentially malignant lesions (PML) are herein reported and compared with the histological diagnosis. METHODS: Either conventional (89) or liquid-based (384) exfoliative cytology was used for the diagnosis of oral dysplasia/carcinoma in 473 subjects and the results were compared with scalpel biopsy histology. Cells were collected using a Cytobrush device for conventional smears and with a dermatological curette for the liquid-based cytology. The 'curette technique' also allowed for the collection of 'accidental' tissue fragments, utilized as microbiopsies. RESULTS: Histological diagnosis was squamous carcinoma in 96 of 473 cases, high-grade dysplasia (oral intraepithelial neoplasia two to three) in 24 and other lesions in 353 cases. The smears in the conventional cytology group were inadequate in 12.4%, with an 85.7% sensitivity and a 95.9% specificity. There were 8.8% of inadequate specimens in the liquid-based cytology group; sensitivity was 95.1% and specificity was 99.0%. CONCLUSIONS: Although conventional cytology is useful when diagnosing oral PML (better sensitivity and predictive positive value if compared with the cervical smear test with similar specificity) and can improve the accuracy of histological diagnosis, liquid-based cytology gives better results, as it not only enhances both sensitivity and specificity, but also provides material for further investigation (AgNORs, DNA, microbiopsies, etc.).