2004-2014年东营市无偿献血者梅毒螺旋体感染情况的调查分析

目的 探讨山东省东营市无偿献血者梅毒螺旋体(TP)的感染情况,以指导本地区献血服务工作,避免输血引起的梅毒传播.方法 选择2004-2014年山东省东营市中心血站招募的215 976例献血者作为研究对象.所有献血者献血前体检及相关血液学检查结果,均符合《献血者健康检查要求》(GB18467-2011)的相关规定.按照献血者出生年份将其分为4个组:1950-1959年出生组(n=4 463)、1960-1969年出生组(n=38 113)、1970-1979年出生组(n=63 126)及1980年以后出生组(n=110 274),每组献血者再按照性别分为男性亚组和女性亚组.对于2004-2013年招募的192 221例献血者按照《血站技术操作规程(2015版)》的相关规定,均采用2个不同厂家生产的酶联免疫吸附试验(ELISA)试剂盒检测TP特异性抗体;对于2014年招募的23 755例献血者,除按照上述规定检测TP特异性抗体外,再增加2遍甲苯胺红不加热血清试验(TRUST)检测TP非特异性抗体.针对ELISA或TRUST试验的TP检测阳性结果,包括TP检测结果为弱阳性、阳性、强阳性的血清样品,再采用梅毒螺旋体明胶凝集试验(TPPA)进行阳性结果确证.采用统计学方法分别比较各个出生年份组,以及每组男性亚组和女性亚组献血者TP阳性率差异.4个不同出生年份组献血者的性别构成比等一般资料比较,差异无统计学意义(P＞0.05).各个不同出生年份组中,不同性别亚组献血者年龄等一般资料比较,差异亦无统计学意义(P＞0.05).结果 ①2004-2014年献血者的TP总阳性率为0.42％(901/215 976),其中女性献血者TP阳性率为0.52％(324/62 599),显著高于男性的0.38％(577/153 377),并且差异有统计学意义(x2=26.08,P＜0.05).②本研究4个不同出生年份组献血者的TP总阳性率、男性及女性亚组献血者TP阳性率,分别比较,差异均有统计学意义(x2=20.88、14.35、8.96,P＜0.05).1970-1979年出生组献血者的TP阳性率最高,为0.56％(352/63 126),其中男性亚组献血者TP阳性率为0.50％(234/46 989),女性亚组为0.73％(118/16 173),分别与1980年后出生组献血者的0.36％(396/110 274)、0.32％(237/73 957)、0.44％(159/395 695)比较,差异均有统计学意义(x2=33.92、24.15、14.55,P＜0.05).③1970年后出生组(1970-1979年出生组与1980年以后出生组)献血者TP阳性率,分别显著高于其他两组(1950-1959年出生组、1960-1969年出生组),并且差异均有统计学意义(x2=35.48、44.43、21.78、17.91;P＜0.05).④同一组献血者中,女性亚组献血者TP阳性率均分别显著高于男性亚组,并且差异均有统计学意义(x2=11.26、34.00、74.38、25.42,P＜0.05).结论 最近11年以来,东营市无偿献血者TP感染情况基本稳定,但女性献血者及1970-1979年出生的献血者TP阳性率较高,应引起足够重视,加强对这部分献血者的健康教育、TP筛查及管理.

Investigation and analysis on infection of Treponema pallidum among voluntary blood donors in Dongying City of Shandong Province from 2004 to 2014

Objective To explore the intection status of Treponema pallidum (TP) among voluntary blood donors in Dongying City of Shandong Province,in order to guide blood donation service in Dongying City of Shandong Province,and prevent syphilis transmitting by blood transfusion.Methods From 2004 to 2014,a total of 215 976 voluntary blood donors who were recruited by Dongying Blood Center Station were included into this study as research objects.Physical examination and related hematology tests results of all blood donors before blood donation were conform to Whole Blood and Blood Component Donor Selection Requirements (GB18467-2011).All of these blood donors were divided into 4 groups according to their birth years:born in 1950-1959 group (n=4 463),born in 1960-1969 group (n=38 113),born in 1970-1979 group (n=63 126),and born after 1980 group (n=110 274),and donors of each group were divided into male subgroup and female subgroup according to their gender.In accordance with Blood Station Technical Operation Procedure (2015 edition),192 221 blood donors who were recruited from 2004 to 2013,were detected TP specific antibody by 2 kinds of enzyme-linked immuno-sorbent assay (ELISA) kits from 2 different manufactures.According to above requirement,23 755 blood donors who were recruited in 2014 were detected TP specific antibody by 2 kinds of ELISA kits,in addition,were added twice toluidine red untreated serum test (TRUST) to detect non-specific antibody.For the serum samples with positive results of TP by ELISA or TRUST test,including weakly positive,positive and strong positive,Treponema pallidum gelatin agglutination test (TPPA) were applied to identify positive results.The differences of TP positive rates in different birth years groups and gender subgroups were compared by statistical methods.There were no significant differences among 4 different birth year groups in gender constituent ratios and others general informations (P＞ 0.05).In each birth year group,there were no significant differences between male and female subgroups in age and other general informations (P＞0.05).Results ① From 2004 to 2014,total positive rate of TP in all donors was 0.42％ (901/215 976),and that of female donors was 0.52％ (324/62 599),which was significantly higher than that of 0.38％ (577/153 377) of male donors,and the difference was statistically significant(x2 =26.08,P＜0.05).② Among the 4 groups of different birth years,there were statistical significant differences of TP total positive rates,and also of TP positive rates in male and female subgroups donors (x2 =20.88,14.35,8.96;P＜0.05),respectively.TP positive rate of donors born in 1970-1979 group was the highest (0.56％,352/63126) one,positive rate of male subgroup was 0.50％ (234/46 989),and that of female subgroup was 0.73％(118/16 173),compare with those of 0.36％(396/110 274),0.32％(237/73 957),and 0.44％ (159/395 695) of donors born after 1980 group,the differences were statistically significant (x2 =33.92,24.15,14.55;P ＜0.05),respectively.③ TP positive rates of donors born after 1970 (including born in 1970-1979 group and born after 1980 group) were significantly higher than those of the other 2 groups (including born in 1950-1959 group and born in 1960-1969 group),and the differences were statistically significant (x2 =35.48,44.43,21.78,17.91;P＜0.05),respectively.④ In the same birth years group,TP positive rates of female subgroups were significantly higher than those of male subgroups,and the differences were statistically significant (x2 =11.26,34.00,74.38,25.42;P＜0.05).Conclusions In recent eleven years,TP positive rates of blood donors were basically stable in Dongying City of Shandong Province,but TP positive rates of female or born in 1970-1979 donors were higher than others.Therefore,enough attention should be paid to strengthen health education,TP screening and management for these part of donors.