19SIgM-TPPA对新生儿先天潜伏梅毒诊断的意义

目的探讨特异性19SIgM-TPPA抗体检测方法在诊断新生儿先天潜伏梅毒中的价值,同时观察妊娠梅毒患者垂直传播发生情况,并探讨其意义。方法应用特异性19SIgM-TPPA抗体检测方法对177例孕妇梅毒所生的新生儿进行检测。结果177例受检新生儿中,TRUST阳性112例(63.3%),TPPA阳性156例(88.13%),19SIgM阳性27例(15.25%)。早期先天梅毒患儿TRUST≥母亲TRUST2个滴度以上9例、>母亲TRUST2个滴度以内7例、<母亲TRUST滴度5例;因母亲血清标本缺或血清量不足,无法作比较的6例。27例先天梅毒有临床表现的6例,无临床表现21例。结论特异性19SIgM-TPPA抗体检测方法可作为先天梅毒特别是无症状新生儿先天梅毒诊断的试验。产前梅毒筛查和治疗对预防梅毒垂直传播有重要意义。     

FTA-ABS-19S-IgM诊断新生儿先天梅毒

探讨梅毒螺旋体特异性FTA—ABS-19S—IgM在新生儿先天梅毒早期诊断中的价值。对23例拟诊为先天梅毒的新生儿行TRUST、TPPA和FTA—ABS-19S—IgM三种梅毒血清学检测，并结合临床表现及母婴梅毒血清学检查对检测结果进行分析。23例新生儿FTA—ABS-19S—IgM均为阳性，其中，有早期先天梅毒的典型临床表现者7例，无症状者16例；在分娩时新生儿TRUST试验滴度等于或大于母亲滴度4倍者6例。23例新生儿中，只有9例依据典型临床表现和／或新生儿TRUST滴度超过母亲4倍作出先天梅毒诊断。梅毒螺旋体特异性。FTA—ABS-19S—IgM试验可作为新生儿先天梅毒尤其是无症状新生儿先天梅毒早期诊断的确证试验.     

TP-IgM-WB早期诊断先天梅毒

目的:评价新生儿血清IgM抗体蛋白免疫印迹实验在先天梅毒早期诊断的作用。方法:在知情同意的情况下,连续选取34例梅毒孕妇及新生儿和40例非梅毒孕妇及新生儿,分别对其进行新生儿血清TP-IgM-WB及FTA-ABS-19S-IgM试验,对母婴进行常规临床检查及梅毒血清学RPR、TPPA试验,进一步将血清TP-IgM-WB试验结果与常规综合方法诊断及FTA-ABS-19S-IgM试验结果进行比较,同时新生儿随访18个月最终诊断,以评价上述方法在先天梅毒早期诊断中的作用。结果:34例孕妇梅毒病例所生的新生儿中,通过随访诊断10例,其中常规综合诊断方法早期诊断9例(确诊3例、拟诊6例先天梅毒),仅6例血清FTA-ABS-19S-IgM试验阳性,而血清TP-IgM-WB试验10例均为阳性。40例非梅毒孕妇及新生儿各项检查均为阴性。TP-IgM-WB与FTA-ABS-19S-IgM试验结果阳性检出率差异有统计学意义(P<0.05);TP-IgM-WB单项检查与常规检查的结果差异无统计学意义(P>0.05)。结论:新生儿血清IgM蛋白印迹试验优于FTA-ABS-19S-IgM试验,与常规检查方法、单项试验显示等同于现行的常规综合诊断方法的诊断价值。     

IgM抗体诊断早期先天梅毒

我们用梅毒特异性19（s)IgM-TPPA抗体检测方法，对5例常规梅毒血清学方法RPR和TPPA两个试验均阳性的新生儿（其母亲已在怀孕时被确诊为不同病期梅毒）进行了检测。患儿中有3例19（s)IgM-TPPA阳性，另2例阴性。最终确诊3例新生儿为先天梅毒。特异性IgM检测应该作为新生儿和早期无症状先天梅毒确诊的实验诊断方法。加强婚前、孕前及早孕期的梅毒筛查和治疗，对控制先天梅毒的发生有重要意义。     

免疫层析技术和化学发光法免疫分析法在梅毒检测中的效果比较

目的:考察全自动微粒子化学发光免疫实验(CMIA)与免疫层析技术(GICA)在梅毒检测中的应用效果差异。方法:采用TPPA法作为金标准检测1500例住院患者血清标准,评价CMIA与GICA在梅毒检测中敏感性和特异性。结果:金标准中1500例血清标本梅毒检出率为12.1%,CMIA阳性检出率为12.5%,GICA为12.7%。CMIA法灵敏度为92.86%,特异性为98.,6%,阳性预测值为89.89%,阴性预测值为99.01%。GICA法灵敏度为98.35%,特异性为99.77%,阳性预测值为98.35%,阴性预测值为99.77%。两组间灵敏度和阴性预测值存在显著差异(P0.05)。结论:GICA的灵敏性和阴性预测值优于GICA法,可以提到TPPA成为梅毒检测的血清学检测首选方法。     

高敏化学发光法检测梅毒特异性抗体的评价

目的评价高敏化学发光法(high sensitivity chemiluminescence enzyme immunoassay,HISCL)检测血清梅毒特异性抗体的临床应用价值。方法盲法平行检测2 014例梅毒可疑或筛查患者血清的梅毒特异性抗体;以梅毒螺旋体明胶凝集试验(TPPA)方法为金标准,评价HISCL法临床应用价值。结果HISCL法灵敏度、特异性、阳性预测值、阴性预测值、阳性似然比、阴性似然比、总符合率和Kappa值分别为97.53%,99.73%,96.93%,99.78%,361.25,0.02,99.55%和0.970。交叉反应试验及干扰试验中,未观察到交叉反应或干扰因素的存在。HISCL法较TPPA具有更强实用性。HISCL法与TPPA结果不符9例,均出现在COI值5.0以下或TPPA滴度为160以下的抗体低效价标本,重组抗原印迹法检测均为梅毒抗体非阴性标本。结论 HISCL法检测梅毒特异性抗体结果与TPPA法有很好一致性,有很高的诊断效能,并具有自动化、高通量、低劳动力成本等优点,可以作为梅毒初筛试验。     

深圳市宝安区2008-2009年孕产妇及新生儿梅毒患病情况分析

目的了解深圳市宝安区孕产妇及新生儿梅毒患病情况,为制定预防与控制梅毒发病和流行的策略提供依据。方法对236853例首次产前保健的孕产妇进行免费甲苯胺红不加热血清试验(TRUST)筛查,试验结果呈阳性者采用梅毒螺旋体明胶颗粒凝聚试验(TPPA)进行确认;其分娩的新生儿1个月内用TRUST,TPPA及19S-IgM-梅毒螺旋体明胶凝集试验(19S-IgM-TPPA)进行检测;对孕妇及新生儿确诊试验结果呈阳性者进行规范治疗,电话随访并进行健康教育。结果 818例孕产妇确诊为妊娠梅毒,患病率为3.45‰;孕妇首次筛查时间多数在孕28周以前;潜伏期梅毒占多数;死胎、死产和自然流产112例,75例终止妊娠;失访117例;多数孕产妇及新生儿TRUST的滴度≤1∶4,12例新生儿血清19S-IgM-TPPA检测阳性;分娩的415例新生儿主要是先天梅毒疑似病例,12例为先天梅毒,阳性率为2.89%。结论早期梅毒筛查、规范治疗、定期随访和科学管理妊娠梅毒是控制梅毒母婴传播的有效方法 。     

两种TP重组抗原血清学试验检测梅毒的灵敏度和特异性比较

目的:考察免疫层析技术(GICA)与酶联免疫吸附检测(TP-ELISA)在梅毒检测中的应用效果差异。方法:采用TP-PA法作为金标准检测1200例住院患者血清标准,评价GICA与TP-ELISA在梅毒检测中敏感性和特异性。结果:金标准中1200例血清标本梅毒检出147例检出率为12.3%,GICA阳性检出率为12.7%,TP-IgM为11.5%。GICA法灵敏度为98.6%(145/147),特异性为99.3%(1046/1053),阳性预测值为阳性预测值为95.4%(145/152),阴性预测值为99.8%(1046/1048)。TP-ELISA法灵敏度为91.8%(135/147),特异性为99.7%(1050/1053),阳性预测值为97.8%(135/138),阴性预测值为98.9%(1050/1062)。两组间灵敏度和阴性预测值存在显著差异(P<0.05)。结论:GICA的灵敏性和阴性预测值优于TP-ELISA法,可以替代TP-PA成为梅毒检测的血清学检测首选方法。     

全自动微粒子化学发光免疫实验与TP-IgM抗体检测在梅毒检测中的应用效果比较

目的:考察全自动微粒子化学发光免疫实验(CMIA)与TP-Ig M抗体检测(TP-ELISA)在梅毒检测中的应用效果差异。方法:采用TPPA法作为金标准检测1000例住院患者血清标准,评价CMIA与TP-ELISA在梅毒检测中敏感性和特异性。结果:金标准中1000例血清标本梅毒检出率为12.3%,CMIA阳性检出率为12.9%,TP-Ig M为11.7%。CMIA法灵敏度为98.4%(121/123),特异性为99.1%(869/877),阳性预测值为93.8%(121/129),阴性预测值为99.8%(869/871)。TP-ELISA法灵敏度为89.4%(110/123),特异性为99.2%(870/877),阳性预测值为94.0%(110/117),阴性预测值为98.5%(870/883)。两组间灵敏度和阴性预测值存在显著差异(P0.05)。结论:CMIA的灵敏性和阴性预测值优于TP-ELISA法,可以替代TP-PA成为梅毒检测的血清学检测首选方法。     

蛋白免疫印迹试验检测新生儿早期先天梅毒21例

目的：评估梅毒螺旋体蛋白印迹试验（TPPA—IgM—WB）在诊断新生儿早期先天梅毒中的作用。方法：对21例梅毒孕妇所产21例新生儿血清,应用梅毒螺旋体蛋白印迹试验（TPPA—IgM—WB）和常规血清学方法（TPPA、RPR、FTA—ABS—IgM）进行检测,评价上述实验诊断方法和常规实验室检测在先天梅毒早期诊断中的作用。结果：21例孕妇梅毒病例所生的21例新生儿中,按常规综合诊断方法10例诊断为先天梅毒,而新生儿血清IgM蛋白印迹试验12例阳性（10例常规方法诊断为先天梅毒）。结论：血清IgM蛋白印迹试验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。     

梅毒螺旋体IgM抗体蛋白印迹试验诊断新生儿胎传梅毒的探讨

目的探讨梅毒螺旋体IgM抗体蛋白印迹试验(Treponema pallidum IgM Western blot，TP-IgM-WB)在新生儿胎传梅毒早期诊断中的价值。方法对8例胎传梅毒新生儿(其母亲均为梅毒)进行TRUST、TPPA，FTA-ABS-19S-IgM和TP-IgM-WB 4种梅毒血清学检查，并结合临床对结果进行比较。结果8例中3例出现胎传梅毒的典型临床表现，包括典型皮肤损害，梅毒新生儿肺炎，伴发心、脑、肝、肾多脏器衰竭；另外5例无胎传梅毒的临床表现。梅毒血清学试验结果：所有8例TP-IgM-WB均为阳性；除1例外，7例FTA-ABS-19S-IgM试验为阳性；3例有症状的胎传梅毒及3例胎传潜伏梅毒中4种梅毒血清学试验均为阳性；1例TRUST和TPPA均阴性，但FTA-ABS-19S-IgM和TP-IgM-WB均阳性；1例FTA-ABS-19S-IgM阴性，但TRUST滴度是母亲的4倍，TPPA和TP-IgM-WB均阳性。结论梅毒螺旋体IgM抗体蛋白印迹试验可作为一种确诊试验应用于新生儿胎传梅毒，尤其是胎传潜伏梅毒的早期诊断。     

19S-IgM-梅毒螺旋体明胶凝集试验对梅毒患者的诊断和评价

目的评价19S-IgM-梅毒螺旋体明胶凝集试验(19S-IgM TPPA)法检测梅毒患者血清中特异性TP-IgM抗体的临床意义.方法采用经IgG/RF免疫吸附剂处理后的93例梅毒患者血清和3例梅毒妇女所生新生儿血清,用TPPA法检测TP-IgM抗体.结果73例未经正规驱梅治疗的梅毒患者血清中,一期梅毒的TP-IgM抗体阳性率78.26%(18/23),二期梅毒的阳性率100%(32/32),隐性梅毒的阳性率47.06%(8/17),3例梅毒妇女所生新生儿血清TP-IgM抗体1例阳性.经正规驱梅治疗RPR转阴的21例梅毒患者血清中TP-IgM抗体阳性率4.76%(1/21).结论采用19S-IgM-TPPA法检测先天梅毒和二期梅毒具有较高的价值,但不宜单独应用诊断一期和隐性梅毒,对梅毒疗效的观察有待进一步研究.     

苍白螺旋体镀银染色检查在一期梅毒诊断中的应用

目的:探讨梅毒螺旋体镀银染色检查在一期梅毒实验诊断中的意义。方法:对37例一期梅毒患者分别采用梅毒螺旋体镀银染色、墨汁负染及暗视野检查3种方法对比检查,同时作快速血浆反应素环状卡片试验(RPR)、梅毒螺旋体血凝试验(TPHA)检测梅毒螺旋体抗体。结果:镀银染色法检查梅毒螺旋体的阳性率高,与墨汁负染法、暗视野检查法的结果比较,其差异有显著性(P<0.05)。镀银染色层次清楚,螺旋体易被着色辨认。结论:梅毒螺旋体镀银染色检查是一期梅毒实验室诊断的有效方法之一。     

Rheumatoid factor in congenital syphilis.

The rheumatoid factor (RF) latex test was evaluated as a test for congenital syphilis. High risk newborns of mothers with untreated or inadequately treated syphilis were studied. The asymptomatic infants were followed up for between 3 and 4 months (or longer if the VDRL test was positive). The overall performance of the RF latex test was better than that of the other tests studied, even though the sensitivity was 46.7%. The specificity and positive predictive value of the test were 100% whilst the negative predictive value was 86.4%. The test was negative in all 84 controls studied. Although a negative RF latex test cannot be used to exclude congenital syphilis in an asymptomatic infant, a positive test in the presence of maternal syphilis should lead one to strongly suspect congenital syphilis.     

Occurrence of congenital syphilis after maternal treatment with azithromycin during pregnancy

OBJECTIVE: To evaluate the efficacy of azithromycin in preventing congenital syphilis. METHOD: Five pregnant women with syphilis who were allergic to penicillin were given azithromycin, 1 g daily orally or intravenously, in different hospitals. The duration of the therapy ranged from 1 day to 10 days. A second course of therapy was provided at 28 weeks gestation. The babies were given a physical examination and blood test for serum rapid plasma reagin test (RPR), treponema pallidum hemagglutination test (TPHA), and fluorescent treponemal antibody adsorption test (FTA-ABS-19-sIgM) within three months after birth. RESULTS: Five infants born to these mothers developed skin rashes. Four of the infants had hepatomegaly and one showed osteochondritis. The tests RPR, TPHA, and FTA-ABS-19-sIgM were positive. The RPR titers varied from 1:64 to 1:256 and the babies were diagnosed with congenital syphilis. They were successfully treated with penicillin. CONCLUSIONS: Successful therapy for syphilis during pregnancy demands maternal care as well as prevention or cure of congenital infection. The failure of azithromycin in preventing congenital syphilis in our report suggests that azithromycin should not be recommended as an alternative in treating syphilitic pregnant women or fetal syphilis.     

治疗干预对不同妊期潜伏梅毒孕妇新生儿影响的研究

目的:探讨对不同妊娠时期的潜伏梅毒孕妇进行驱梅治疗后对其新生儿的影响。方法:对早、中、晚妊娠并发潜伏梅毒的50例孕妇分别进行驱梅治疗,于新生儿出生一个月内进行梅毒快速反应试验(RPR)、梅毒螺旋体颗粒凝集试验(TPPA)和梅毒IgM(TP-IgM)检测,比较新生儿先天性梅毒的发病状况,并与13例未经治疗的潜伏梅毒妊娠所生新生儿的检测结果相对照。结果:不同时期妊娠并发潜伏梅毒经驱梅治疗后,新生儿先天性梅毒的发生率分别为5.00%、14.29%、35.71%,而未经治疗的潜伏梅毒孕妇所生新生儿先天性梅毒的发生率为76.92%,差异有统计学意义(P<0.05)。结论:及早对孕妇进行梅毒血清学筛查并及时对潜伏梅毒孕妇进行驱梅治疗是降低新生儿先天性梅毒发病率的关键。     

229例梅毒患者临床和脑脊液分析

目的 分析治疗半年后梅毒甲苯胺红不加热血清试验（TRUST）滴度下降小于4倍或再升高梅毒患者的临床与脑脊液特征,探讨其TRUST滴度下降低于4倍或再升高的原因.方法 对本院229例治疗半年后TRUST滴度下降小于4倍或再升高梅毒患者行腰穿进行脑脊液常规、生化、IgG指数、TRUST、梅毒螺旋体明胶凝集试验（TPPA）、荧光螺旋体抗体吸收试验（FTA-ABS）及性病研究实验室试验（VDRL）检测.结果 229例患者中有症状神经梅毒20例,无症状神经梅毒15例,HIV感染6例.结论 TRUST滴度下降小于4倍或再升高与梅毒螺旋体中枢神经系统感染有关,要及时腰穿行脑脊液检查以早期发现神经梅毒.     

IgM rheumatoid factor removal and performance of the FTA-ABS (IgM) test in congenital syphilis.

OBJECTIVE--To determine the performance of the FTA-ABS (IgM) test in congenital syphilis after eliminating interference by IgM rheumatoid factor (RF) and preventing competitive inhibition by IgG. DESIGN--The FTA-ABS (IgM) test was carried out before and after RF removal (achieved by immunoprecipitation of the IgG) in infants with congenital syphilis and controls. SETTING--Newborns delivered in the Peninsula Maternal and Neonatal Services in Cape Town and infants presenting at Red Cross War Memorial Children's Hospital. SUBJECTS--Infants with congenital syphilis aged 0-4 months were divided into those with clinical signs at presentation and those who were asymptomatic at delivery. In addition, patients without congenital syphilis but with similar clinical signs at presentation were investigated as were control infants. OUTCOME MEASURE--The diagnosis of congenital syphilis was based on the criteria suggested by Kaufman et al (1977). RESULTS--Amongst symptomatic infants with congenital syphilis the FTA-ABS (IgM) test was positive in 34 (92%) of 37 cases prior to abolishing the RF effect and in 29 (78.4%) of 37 cases afterwards (p = 0.19). In 12 cases of congenital syphilis who were asymptomatic at birth, 10 had positive FTA-ABS (IgM) tests before RF removal and only three had positive tests afterwards (p = 0.006). False positive tests were not found amongst 15 symptomatic infants whose clinical features mimicked those of the infants with congenital syphilis. Among 51 healthy infants the test had a false-positive rate of 2% in newborns and 13% in older infants. The false positive reactions were eradicated by IgG precipitation. CONCLUSIONS--Following IgG and RF removal there was an improvement in the specificity of the FTA-ABS (IgM) test but this was at the expense of a loss of sensitivity, particularly in asymptomatic newborns. For newborns, if the FTA-ABS (IgM) test was positive, the patient was likely to require treatment for congenital syphilis, regardless of whether the result was due to the presence of RF or specific IgM.     

广西地区梅毒螺旋体阿奇霉素耐药基因23SrRNA流行病学研究

目的:了解广西地区梅毒螺旋体耐阿奇霉素基因23SrRNA突变的流行状况。方法:采集广西不同地区性病门诊疑似早期梅毒患者300例组织液,先进行PCR检测梅毒螺旋体DNA,阳性标本再进行巢式PCR检测Mbo Ⅱ酶切23SrRNA基因。结果:梅毒DNA阳性215例,其中耐药检测有效菌株数为190株,阿奇霉素23SrRNA基因突变耐药菌株数为173株,耐药率91.1%(173/190)。结论:广西地区梅毒螺旋体阿奇霉素耐药率高。