三种方法检测梅毒螺旋体抗体的比较

应用ELISA法、TRUST法和TPPA法分别检测梅毒患者血清标本中梅毒螺旋体IgG抗体,比较3种方法的敏感性和特异性,选择一种适合于梅毒螺旋体抗体检测的高敏感性和高特异性的血清学检测方法。     

梅毒实验室诊断的分子生物学方法

本文综述了梅毒的实验室诊断的分子生物学方法,特别是多聚酶链反应（ＰＣＲ）和Ｗｅｓｔｅｒｎ免疫印迹等新的分子生物学检测技术在诊断早期梅毒、先天性梅毒和神经性毒素等方面的研究进展,着重讨论了ＰＣＲ诊断梅毒的多方面情况,并对ＰＣＲ、Ｗｅｓｔｅｒｎ免疫印迹技术与经典兔感染试验进行了评价。     

早期先天梅毒几种实验室诊断方法的评价

目的评价梅毒螺旋体蛋白印迹试验(TPPA-IgM-WB)和梅毒螺旋体19(s)-IgM酶联免疫吸附法[TP-19(s)-IgM-ELISA]在先天梅毒早期诊断中的作用。方法对45例梅毒孕妇所产46例(1例双胞胎)新生儿运用血清IgM-WB试验、梅毒螺旋体19(s)-IgM酶联免疫吸附法[TP-19(s)-IgM-ELISA]和常规血清学方法(TPPA、RPR、FTA-ABS-IgM)检测,评价上述试验诊断方法在先天梅毒早期诊断中的作用。结果45例梅毒孕妇所生的新生儿中,按常规综合诊断方法21例确诊为先天梅毒,新生儿血清IgM蛋白印迹试验23例阳性,梅毒螺旋体19(s)-IgM酶联免疫吸附法24例阳性(21例常规方法诊断为先天梅毒)。30例作为对照的非梅毒孕妇及新生儿各项检查均为阴性。结论血清IgM蛋白印迹试验和梅毒螺旋体19(s)-IgM酶联免疫吸附法[TP-19(s)-IgM-ELISA]诊断先天梅毒具有较高的特异性和敏感性,结果显示可能高于现行的常规综合诊断方法的诊断价值。     

Immuno-PCR法诊断早期梅毒的方法学建立及其应用

目的建立Immuno-PCR法诊断早期梅毒的方法学,评价其灵敏度、特异性、重复性及其临床应用。方法利用基因重组TpN47抗原免疫新西兰兔,制备抗体并用Weston blotting检测;利用抗TpN47抗体作为捕获抗体与血清中TpN47抗原结合,通过链霉亲和素、生物素化抗体、生物素化DNA和PCR扩增等建立Immuno-PCR法检测梅毒螺旋体抗原TpN47体系;评价该方法的灵敏度、特异性和重复性;收集200例临床标本通过Immuno-PCR法、ELISA、TPPA和TURST法进行临床应用比较。结果 Weston blotting结果显示TpN47抗体阳性;Immuno-PCR比ELISA法敏感性强103倍,比TPPA、TURST强105倍;特异性高,重复性好。临床标本中Immuno-PCR法敏感性和特异性分别为86.00%（P〈0.05）和100.00%,ELISA法为71.00%和98.00%,TPPA法为65.00%和100.00%,TRUST法为68.00%和95.00%。结论 Immuno-PCR法检测梅毒螺旋体TpN47抗原敏感性高,特异性强,重复性好,可作为梅毒螺旋体感染的早期诊断方法 。     

15881例患者梅毒血清学诊断的方法学比较

目的了解本区域特殊群体梅毒检测的方法学意义。方法对2010—2013年在大连市皮肤病医院进行梅毒血清学检测的15881例患者和其中确证梅毒患者6488例资料进行回顾性分析,同时评价TRUST、TP—ELISA、TPPA和乳胶层析法检测特殊群体患者血清的意义。结果2010—2013年梅毒血清学阳性患者分别为1347例、1679例、1787例、1675例,共6488例,占大连市沙河口区梅毒确诊患者的82．13％、82．02％、75．18％、71．67％。TRUST、TP-ELISA、TPPA和乳胶层析法敏感性分别为74．48％、99．75％、99．46％、86．24％,特异性分别为99．65％、99．98％、99．95％、99．92％。结论梅毒患者和全国一样,有死灰复燃的趋势,且有从高危人群向普通人群蔓延的趋势;在大样本梅毒血清学试验中,TRUST和TP—ELISA结合法具有高度敏感性和特异性,可作为高危人群体检的方法首选。     

胶体金法与TPPA法检测梅毒特异性抗体的对比研究

目的 :探讨梅毒螺旋体特异性抗体胶体金法 (TPAb)在临床工作中的应用。方法 :以梅毒累旋体明胶凝集试验 (TPPA)为“金标准” ,同时用TPAb法检测梅毒高危人群的血清。结果 :两种方法经 χ2 检验P >0 0 5 ,差异没有显著性 ,Kappa值为 0 86 ,TPAb法其敏感性 88 9% ,特异性 97 8% ,准确性 93%。结论 :TPAb法可推荐用于血清学梅毒特异性抗体检查 ,有助于临床梅毒的快速诊断     

3种梅毒诊断实验对梅毒患者的临床诊断效果对比

目的:对比TPPA(梅毒螺旋体明胶颗粒凝集实验)、RPR(快速血浆反应测定)和USR(不加热血清反应素实验)对不同临床分期梅毒患者的临床诊断效果。方法:回顾性分析疑似梅毒病患共113人,其中被确诊为梅毒的99人,其余14人正常。对113人均采用RPR和USR初筛实验和TPPA梅毒确诊实验。评价RPR、USR、TPPA三种诊断的敏感性、特异性、阳性预测值和阴性预测值。结果:RPR和USR对梅毒诊断的敏感性、特异性、阳性预测值和阴性预测值差异无统计学意义(P0.05)。TPPA各项值均高于RPR和USR,差异有统计学意义(P均0.05)。RPR、USR对Ⅰ、Ⅱ和Ⅲ期梅毒确诊率无统计学差异(P0.05),但TPPA对Ⅰ、Ⅱ期梅毒确诊率基本为100%,但是对Ⅲ期梅毒的确诊率降低,且差异有统计学意义(P0.05)。结论:USR和RPR对临床梅毒均存在一定的误诊率,为提高临床疑似病例确诊率,应联合梅毒检测,TPPA虽为确诊实验,但对Ⅲ期梅毒仍有一定的漏诊率。     

化学发光微粒子免疫法和梅毒螺旋体颗粒凝集试验检测梅毒抗体的比较

目的评价化学发光微粒子免疫法（chemiluminescence microparticle immunoassay, CMIA）检测临床血清标本梅毒螺旋体抗体的敏感性和特异性。方法用梅毒螺旋体颗粒凝集试验（TVeponema Pallidum particie agglutination test,TPPA）法作为对照标准,采用CMIA法检测2012年11月到12月1200例住院患者的血清标本,并用卡方检验评价两种检测方法对同一个样本的化验结果的一致性。结果1200例血清标本中用CMIA法检出阳性率为11.3%,TPPA法检出阳性率为10. 9% ,以TPPA为标准,CMIA法敏感性为96. 9%,特异性为99. 2%,其中CMIA法检测血清S/CO值〉 4. 00的110例,用TPPA确认107例阳性,阳性预测值（PPV）为97.3%;CMIA法S/C0值在1.0-9.0,TPPA可出现阴性结果。结论CMIA法可替代TPPA法进行梅毒螺旋体抗体检测,对于CMIA法检测S/C0值1. 0-4.0的需进一步复检。     

现用梅毒血清试验临床应用价值评估

通过检测梅毒患者正规治疗前、后血清抗体变化,评价梅毒实验室各种血清学试验方法对梅毒的诊断和随访的临床意义.本文采用梅毒螺旋体(TP)暗视野显微镜检查、快速血浆反应素(RPR)试验、TP明胶凝集试验(TPPA)和TP-IgM酶联免疫吸附试验(TP-IgM ELISA)等方法对135例梅毒患者正规治疗前、后的血清进行检测....     

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 sequence of the acidic repeat protein (arp) gene differentiates venereal from nonvenereal Treponema pallidum subspecies, and the gene has evolved under strong positive selection in the subspecies that causes syphilis

Despite the completion of the Treponema pallidum genome project, only minor genetic differences have been found between the subspecies that cause venereal syphilis (ssp. pallidum) and the nonvenereal diseases yaws (ssp. pertenue) and bejel (ssp. endemicum). In this paper, we describe sequence variation in the arp gene which allows straightforward differentiation of ssp. pallidum from the nonvenereal subspecies. We also present evidence that this region is subject to positive selection in ssp. pallidum, consistent with pressure from the immune system. Finally, the presence of multiple, but distinct, repeat motifs in both ssp. pallidum and Treponema paraluiscuniculi (the pathogen responsible for rabbit syphilis) suggests that a diverse repertoire of repeat motifs is associated with sexual transmission. This study suggests that variations in the number and sequence of repeat motifs in the arp gene have clinical, epidemiological, and evolutionary significance.     

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。     

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.     

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.