Georgetown University School of Medicine, Washington, DC.
From the Department of Medicine.
Sex Transm Dis. 2023 Aug 1;50(8):472-478. doi: 10.1097/OLQ.0000000000001813. Epub 2023 Apr 1.
Routinely available laboratory tests for Treponema pallidum remain suboptimal for diagnostic, prognostic, predictive, and monitoring purposes. Biomarkers with enhanced performance characteristics can improve diagnostic confidence and facilitate management. We conducted a systematic review to examine the utility of biomarkers in the diagnosis and management of syphilis.
We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify articles for inclusion and independently reviewed them for eligibility and study quality using a 3-stage procedure. The search, conducted by a senior library informationist, used PubMed, Embase, Cochrane Library, and Scopus and included any study published before May 2022.
Of the 111 studies identified, 31 (27.9%) were included in our review. Most studies were cross-sectional or prospective. The data were strikingly heterogeneous examining a variety of biomarkers across different syphilis stages, using different methodologies and definitions of treatment success. Available publications chiefly focused on diagnosing various syphilis stages, neurosyphilis and congenital syphilis, serological cure, the serofast state, and reinfection.
Despite increasing attempts to identify novel biomarkers, we found limited evidence to support the use of any biomarker in clinical decision making at this time; the syphilis biomarker literature is heterogenous and lacks measurement of clinically meaningful end points. We recommend the formation of a working group to set priorities for syphilis biomarker research and to guide future study of clinically meaningful biomarkers.
目前用于诊断、预后、预测和监测苍白密螺旋体的常规实验室检测仍不理想。具有增强性能特征的生物标志物可以提高诊断信心并有助于管理。我们进行了一项系统评价，以检查生物标志物在梅毒诊断和管理中的应用。
我们使用系统评价和荟萃分析的首选报告项目来确定纳入的文章，并使用 3 阶段程序独立审查其资格和研究质量。高级图书馆信息专家进行的搜索使用了 PubMed、Embase、Cochrane 图书馆和 Scopus，并包括 2022 年 5 月之前发表的任何研究。
在确定的 111 项研究中，有 31 项（27.9%）被纳入我们的综述。大多数研究是横断面或前瞻性的。研究数据在检查各种梅毒阶段、神经梅毒和先天性梅毒、血清学治愈、血清固定状态和再感染的各种生物标志物时，使用不同的方法和治疗成功定义，存在明显的异质性。现有的出版物主要集中在诊断各种梅毒阶段、神经梅毒和先天性梅毒、血清学治愈、血清固定状态和再感染上。
尽管人们越来越努力地寻找新的生物标志物，但我们发现目前几乎没有证据支持在临床决策中使用任何生物标志物；梅毒生物标志物文献存在异质性，并且缺乏对临床有意义终点的测量。我们建议成立一个工作组，为梅毒生物标志物研究确定优先事项，并指导未来对有临床意义的生物标志物的研究。
