梅毒实验室指南:非梅毒螺旋体抗体试验的性能特征。
Syphilis Laboratory Guidelines: Performance Characteristics of Nontreponemal Antibody Tests.
机构信息
Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
出版信息
Clin Infect Dis. 2020 Jun 24;71(Suppl 1):S21-S42. doi: 10.1093/cid/ciaa306.
We reviewed the relevant syphilis diagnostic literature to address the following question: what are the performance characteristics, stratified by the stage of syphilis, for nontreponemal serologic tests? The database search included key terms related to syphilis and nontreponemal tests from 1960-2017, and for data related to the venereal disease research laboratory test from 1940-1960. Based on this review, we report the sensitivity and specificity for each stage of syphilis (primary, secondary, early latent, late latent, or unknown duration; tertiary as well as neurosyphilis, ocular syphilis, and otic syphilis). We also report on reactive nontreponemal tests in conditions other than syphilis, false negatives, and automated nontreponemal tests. Overall, many studies were limited by their sample size, lack of clearly documented clinical staging, and lack of well-defined gold standards. There is a need to better define the performance characteristics of nontreponemal tests, particularly in the late stages of syphilis, with clinically well-characterized samples. Published data are needed on automated nontreponemal tests. Evidence-based guidelines are needed for optimal prozone titrations. Finally, improved criteria and diagnostics for neurosyphilis (as well as ocular and otic syphilis) are needed.
我们回顾了相关的梅毒诊断文献,以解决以下问题:非梅毒螺旋体血清学检测在梅毒各期的表现特征如何?数据库检索包括 1960 年至 2017 年间与梅毒和非梅毒检测相关的关键词,以及 1940 年至 1960 年间与性病研究实验室检测相关的数据。基于这项综述,我们报告了梅毒各期(一期、二期、早期潜伏、晚期潜伏或持续时间未知;三期以及神经梅毒、眼部梅毒和耳部梅毒)的敏感性和特异性。我们还报告了非梅毒情况下的非梅毒螺旋体反应性检测、假阴性和自动化非梅毒螺旋体检测的情况。总体而言,许多研究受到样本量小、缺乏明确记录的临床分期以及缺乏明确界定的金标准的限制。需要更好地定义非梅毒螺旋体检测的性能特征,特别是在梅毒的晚期,使用具有良好临床特征的样本。需要有关于自动化非梅毒螺旋体检测的发表数据。需要制定最佳前带滴定的循证指南。最后,需要改进神经梅毒(以及眼部和耳部梅毒)的标准和诊断方法。
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