Pâris-Hamelin A, Debruyne M, Fustec-Isarboure S
Centre de Biologie Médicale Spécialisée, Institut Pasteur, Paris.
Ann Pharm Fr. 1999 Jan;57(1):68-75.
The lipid antigens used in the Bordet-Wassermann and prepared by Landsteiner and Marie for syphilis tests from 1909 to 1949 were non specific but have certain common features with the spirochete body. For more than forty years the Bordet-Wassermann reaction, associated with flocculation (Kahn) or agglutination (Kline-VDRL) was used to detect cases of tremonematosis despite frequent false positives reactions due to other infections. In 1949, the Nelson and Mayer test was introduced. This test was based on a rigorously specific reaction based on an antigen of live virulent Treponema pallidum. Culture being impossible, the strain had to be, and still is, maintained by weekly passage on rabbit testicles. These manipulations are very dangerous and the technique is difficult, being performed only in specialized laboratories. This test however made it possible to identify the specificity of lipid tests and led to the development of specific immunofluorescent reactions (FTA) in 1959 and of hemagglutination test (TPHA) in 1969. In 1980, we introduced a simple treponemic reaction (FTA or TPHA) associated with a lipid reaction (VDRL) for screening. The specificity of these tests is not however perfect and the Nelson test remains useful as a highly specific reaction. A simple test with comparable specificity was long awaited and is now available with immunoblotting as for HIV, boreliosis and pertussis, etc. We propose this new reaction to replace the Nelson test because it is specific, is sensitive early, distinguishes between IgG and IgM and is not dangerous to manipulate. We have tested it in over one hundred selected sera of CSF from subjects with recent, former or nervous syphilis as well as cases susceptible of producing false positive reactions and have concluded that immunoblotting is highly specific and sensitive. We recommend official approval of this test to replace the Nelson test.
1909年至1949年期间，用于梅毒检测的博德特 - 瓦色曼反应中所使用的脂质抗原由兰德施泰纳和玛丽制备，这些抗原是非特异性的，但与螺旋体有某些共同特征。四十多年来，与絮凝反应（卡恩反应）或凝集反应（克莱因 - 性病研究实验室反应）相关的博德特 - 瓦色曼反应一直被用于检测梅毒病例，尽管由于其他感染经常出现假阳性反应。1949年，尼尔森和迈耶试验被引入。该试验基于一种严格特异性的反应，其依据是活的有毒力梅毒螺旋体的抗原。由于无法进行培养，该菌株过去必须且现在仍然要通过每周在兔睾丸上传代来维持。这些操作非常危险，技术难度大，仅在专业实验室进行。然而，该试验使得确定脂质检测的特异性成为可能，并在1959年促成了特异性免疫荧光反应（荧光密螺旋体抗体吸收试验）的发展以及在1969年促成了血凝试验（梅毒螺旋体血细胞凝集试验）的发展。1980年，我们引入了一种简单的梅毒螺旋体反应（荧光密螺旋体抗体吸收试验或梅毒螺旋体血细胞凝集试验）与脂质反应（性病研究实验室反应）相结合用于筛查。然而，这些检测的特异性并不完美，尼尔森试验作为一种高度特异性的反应仍然有用。人们长期期待一种具有可比特异性的简单检测方法，现在免疫印迹法已经可以用于梅毒检测，就像用于检测艾滋病毒、莱姆病和百日咳等疾病一样。我们提议用这种新反应取代尼尔森试验，因为它具有特异性，早期敏感，能区分IgG和IgM，且操作不危险。我们已经在一百多份来自近期、既往或神经梅毒患者以及可能产生假阳性反应的病例的脑脊液选定血清中对其进行了检测，并得出结论：免疫印迹法具有高度特异性和敏感性。我们建议官方批准该试验以取代尼尔森试验。
