目的：研究三种常用的不同血清学诊断方法对梅毒螺旋抗体的检测效果，从而为提高梅毒螺旋抗体的检出率提供较好的诊断方法。方法：选取2013年1月至2014年7月于我科门诊就诊的274例患者为观察对象，根据有无感染梅毒将其分为两组，其中177例感染梅毒患者为观察组，97例非梅毒患者为对照组，分别应用酶联免疫吸附试验（ELISA）、梅毒螺旋体明胶颗粒凝集试验（TPPA）、甲苯胺红不加热血清试验（TRUST）三种常用的不同血清学诊断方法对两组患者进行梅毒螺旋抗体的检测，分别比较三种检测方法检测的梅毒螺旋抗体的阳性例数、敏感性和特异性，并进行分析。结果：在检测梅毒患者血清标本的阳性率方面，ELISA 法最高，为98.87％，TRUST 法最低，为88.70％，ELISA 法与 TPPA 法比较，差异无统计学意义（P ＞0.05），TRUST 法分别与 ELISA 法、TPPA 法比较，差异均具有统计学意义（P ＜0.05）；ELISA 法、TRUST法、TPPA 法检测梅毒患者血清的敏感性分别为98.87％、88.70％、97.18％，特异性分别为98.97％、95.88％、100.00％，阴性预测值分别为97.96％、82.30％、95.10％，阳性预测值分别为99.43％、97.52％、100.00％；ELISA 法敏感性和阴性预测值最高，与 TRUST 法比较，差异有统计学意义（P ＜0.05）；TPPA 法特异性和阳性预测值最高，与 TRUST 法比较，差异有统计学意义（P ＜0.05）；三种血清学检测方法同时显示梅毒患者血清阳性者有155例，同时显示阴性者有1例，TRUST 法显示阴性而 TPPA 法和 ELISA 法显示阳性者17例。结论：三种血清学检测方法的侧重点各不相同，ELISA 法适用于大批量样本筛查、TPPA 法适用于进行梅毒确诊、TRUST 法应用于对梅毒患者治疗疗效及预后的判断，在临床中应结合实际情况进行选择。%Objectives:To investigate three kinds of commonly used different serological diagnostic methods for detecting the effect of syphilis antibodies,thusly providing better diagnostic methods in order to improve the de-tection rate of syphilis antibodies.Methods:274 patients in my outpatient clinic from January 2013 to July 2014 were selected and,according to the presence or absence of syphilis infection,were divided into two groups:177 ca-ses of syphilis patients in the observation group,and 97 cases of non -syphilis patients in the control group.3 kinds of commonly used serological diagnostic methods,i.e.enzyme -linked immunosorbent assay (ELISA),Treponema pallidum particle agglutination test (TPPA)and toluidine red unheated serum test (TRUST)were used to detect syphilis antibodies of both groups.The number of treponema antibody positive cases,the sensitivity and specificity of the three detection methods were compared and analyzed.Results:ELISA (98.87%)had the highest positive rate of serum samples and TRUST (88.70%)had the lowest,without statistically significant difference between TP-PA and ELISA (P >0.05),but statistically significant difference between TRUST and ELISA /TPPA (P <0.05). The sensitivity of ELISA,TRUST and TPPA was 98.87%,88.70% and 97.18%;specificity was 98.97%, 95.88% and 100.00%;negative predictive values was 97.96%,82.30% and 95.10%;and positive predictive value was 99.43%,97.52% and 100.00%.ELISA had the highest sensitivity and negative predictive value, which was statistically and significant different from the TRUST (P <0.05);TPPA had the highest specificity and positive predictive value,with statistically significant difference from the TRUST (P <0.05).155 cases were found positive by all the 3 methods;1 case was found negative;17cases were found negative by TRUST and positive by TPPA and ELISA.Conclusion:The 3 serological detection methods are of different advantages:ELISA applies to large quantities of sample screening;TPPA law applies to syphilis diagnosis,and TRUST method applies to syphilis therapy and prognosis.Therefore,it should be choosen combined with the actual situation in clinical.
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