目的 探讨在婚、孕前检查梅毒筛查中适用的梅毒血清学检测策略。方法 选择于2022年6月至2024年5月在本区妇幼保健所婚孕检中心做婚前医学检查+孕前优生健康检查的3 852人为研究对象,采集受检者血清标本,分别采用梅毒螺旋体抗体胶体金试纸（胶体金法）、化学发光免疫分析法（CLIA）、快速血浆反应素环状卡片试验（RPR）进行梅毒血清学筛查,检出的阳性标本再采用梅毒螺旋体明胶颗粒凝集试验（TPPA ）进行复查确证。本试验中将TPPA检测结果视为金标准。分析各个方法阳性检出率、检测性能等情况。结果 3 852份血清标本梅毒抗体初筛检测,胶体金法阳性37例（阳性检出率0.96%）,RPR阳性25例（阳性检出率0.65%）,CLIA法阳性41例（阳性检出率1.06%）,梅毒抗体初筛阳性标本合计42例（阳性检出率1.09%）,最后经TPPA确证梅毒抗体阳性39例（阳性检出率1.01%）。胶体金法、CLIA法、胶体金法+CLIA+RPR 的阳性检出率无统计学意义（P>0.05）,且均高于RPR的阳性检出率,差异有统计学意义（P<0.05）。以TPPA检测结果为金标准,胶体金法、CLIA法、胶体金法+CLIA +RPR的灵敏度和准确率无统计学意义（P>0.05）,且均高于RPR,差异有统计学意义（P<0.05）。几种方法的特异度无统计学意义（P>0.05）。结论 在婚、孕前检查梅毒筛查中先用胶体金法检测出快检报告,再用CLIA法检测,阳性做RPR检测,3种方法联合使用可保证梅毒筛查的快速、灵敏、准确、有效,最大限度减少漏诊和误诊的可能性,对于及早发现梅毒感染,及时提供干预措施。

Objective To explore the value of using different syphilis serological tests in the diagnosis of syphilis. Methods From June 2022 to May 2024, a study was conducted on 3 852 individuals who underwent both premarital medical examinations and pre pregnancy eugenics health examinations at the Maternal and Child Health Center in our district. Blood samples were collected from the subjects and subjected to colloidal gold method (TP), rapid plasma reactive ring card test (RPR), and chemiluminescence method (CLIA). The detection rate, diagnostic efficacy, and staging detection of each protocol were analyzed based on the comprehensive evaluation results as the gold standard. Results The 3 852 serum samples were preliminarily screened for syphilis antibodies, with 37 positive cases detected by colloidal gold method (positive detection rate 0.96%), 25 positive cases detected by RPR method (positive detection rate 0.65%), and 41 positive cases detected by CLIA method (positive detection rate 1.06%). A total of 42 samples were preliminarily screened for syphilis antibodies (positive detection rate 1.09%), and finally confirmed by TPPA as positive for syphilis antibodies in 39 cases (positive detection rate 1.01%). There was no significant difference in the positive detection rates of colloidal gold method, CLIA method, and colloidal gold method+CLAI+RPR (P>0.05), and all were higher than the positive detection rate of RPR, with statistical significance (P<0.05). Using TPPA detection results as the gold standard, there was no significant difference in sensitivity and accuracy among colloidal gold method, CLIA method, colloidal gold method+CLAI+PRR (P>0.05), and all were higher than RPR, with statistical significance (P<0.05). There was no significant difference in specificity among several methods (P>0.05). Conclusions In marriage, pregnancy check syphilis screening with colloidal gold detection quick test report, then use CLIA method detection, positive RPR detection, combined use of three methods can guarantee rapid, sensitive, accurate and effective, syphilis screening minimize the possibility of missed diagnosis and misdiagnosis, for early detection of syphilis infection, provide timely intervention