梅毒螺旋体IgM蛋白印迹试验诊断先天性梅毒评价

【作者】 梁平； 汤伍辉； 邵群； 李慧英； 李彬； 魏建萍；

【机构】 景德镇市皮肤病医院； 江西省景德镇市疾控中心； 江西省景德镇市妇幼保健院；

【摘要】 目的:以随访结果为依据,评价梅毒螺旋体IgM蛋白印迹试验(WB-TP-IgM)在诊断先天梅毒中的实际应用价值。方法:2003年3月～2006年2月间,所有梅毒孕妇分娩的婴儿初次就诊时进行病史采集、体格检查、血常规、B超、长骨X射线、梅毒常规血清学检查(RPR、TPPA)和WB-TP-IgM,按1月龄、3月龄、6月龄随访、12月龄、18月龄进行随访或随访到明确排除先天梅毒,参照随访结果,回顾评价WB-TP-IgM。结果:进入研究中的339例梅毒婴儿中,141名婴儿完成随访,随访确定先天梅毒18例(有症状14例,无症状4例),验前概率12．77％。WB-TP-IgM阳性17例(12．06％,17／141), 真阳性14例,假阳性3例,假阴性4例,真阴性120例;敏感性为77．78％[有症状71．43％(10／14),无症状100％(4／4)], 特异性为97．56％,诊断指数175．34％;阳性预测值80．44％,阴性预测值97．14％,调整后的阳性预测值75．53％,阴性预测值97．12％;阳性似然比31．89,阴性似然比0．23。结论:WB-TP-IgM用于诊断先天梅毒的确是一项良好的预测工具, 虽然WB-TP-IgM诊断先天梅毒的性能较好,但在阳性结果中还是有误诊,阴性结果中还是有漏诊,临床医生要从多角度来确定婴儿是否感染梅毒而不能单凭一项试验结果。更多还原

【Abstract】 Objective Depending on follow-up, to evaluate the practical value of scrum Treponema pallidum IgM Western blot assay (WB-TP-IgM) in laboratory diagnosis of early congenital syphilis. Methods From March 1, 2003 to February 28, 2006, any infants bom by pregnant women with syphilis were taken history, physical examination, blood routine test, B-supersonies, X-ray, syphilis routine tests and WB-TP-IgM when they visited first, then follow-up until their diagnoses were defined within 1.5 years. WB-TP-IgM was retrospectively evaluted in accordance with follow-up. Results There are 339 infants in the study. among them 141 infants were follow ed up. 18 infants were diagnosesed to be early congenital syphilis (14 symptomatic cases and 4 asymptomatic cases). In the 18 infants with congenital syphilis, positive, false-positive and false-negative results of WB-TP-IgM occurred in 17, 3 and 4 cases, respectively. Its sensitivity, specificity, diagnostic index, positive and negative predictive value, adjusted positive and negative predictive value, and positive and negative likelihood ratio were 77.78%, 97.56% 175.34%, 80.44%, 97.14%, 75.53%, 97.12%, 31.89,0.228, respectively. Conclusions WB-TP-IgM is a well predicting tool in the diagnosis of congenital syphilis with good sensitivity and specificity. Nevertheless, WB-TP-IgM produces both false-positive and false-negative results, so it is important that clinicians not only consider scrum tests but more aspects in the diagnosis of congenital syphilis.更多还原