Xiao Yao, Tong Man-Li, Yang Yang, Gu Wei-Ming, Liu Li-Li, Yang Tian-Ci
Center of Clinical Laboratory, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Department of Hospital Infection Management, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.
Heliyon. 2023 Jun 12;9(6):e17157. doi: 10.1016/j.heliyon.2023.e17157. eCollection 2023 Jun.
The cerebrospinal fluid (CSF) venereal disease research laboratory (VDRL) test remains the standard for the laboratory diagnosis of neurosyphilis. The toluidine red unheated serum test (TRUST) is an alternative to the VDRL test as a serological test for syphilis, but it lacks guidelines for its use in CSF for neurosyphilis diagnosis.
A total of 210 suspected neurosyphilis patients were included, consisting of 124 neurosyphilis patients and 86 syphilis/non-neurosyphilis patients. The TRUST was modified into the CSF-TRUST-10 test with 10 μL of antigen by referring to the CSF-VDRL test, and the CSF-TRUST-17 test with 17 μL of antigen by referring to its procedures in serum. The diagnostic performance of the CSF-TRUST-10 and CSF-TRUST-17 tests and the concordance between them and the CSF-VDRL test were evaluated.
The diagnostic performance of the CSF-TRUST-10 and CSF-TRUST-17 tests for diagnosing neurosyphilis were comparable to the CSF-VDRL test, as well as the positive rate. The agreement rate was 98.7% between the qualitative CSF-TRUST-10 and CSF-VDRL tests. A total of 91.4% of the quantitative CSF-TRUST-10 results were consistent with the CSF-VDRL test, and the discordant results were no more than two titres. The agreement rate was 98.1% between the qualitative CSF-TRUST-17 and CSF-VDRL tests and 87.6% between the quantitative CSF-TRUST-17 and CSF-VDRL tests.
The CSF-TRUST with 10 μL of antigen could be an alternative for the CSF-VDRL test for neurosyphilis diagnosis. Our results provide a basis for using the TRUST to guide the diagnosis of neurosyphilis.
脑脊液（CSF）性病研究实验室（VDRL）检测仍是神经梅毒实验室诊断的标准。甲苯胺红不加热血清试验（TRUST）作为梅毒血清学检测可替代VDRL试验，但缺乏其用于脑脊液诊断神经梅毒的指南。
共纳入210例疑似神经梅毒患者，其中124例为神经梅毒患者，86例为梅毒/非神经梅毒患者。参照脑脊液VDRL试验，将TRUST改良为用10μL抗原的脑脊液TRUST - 10试验；参照其血清检测程序，将TRUST改良为用17μL抗原的脑脊液TRUST - 17试验。评估脑脊液TRUST - 10和脑脊液TRUST - 17试验的诊断性能以及它们与脑脊液VDRL试验之间的一致性。
脑脊液TRUST - 10和脑脊液TRUST - 17试验诊断神经梅毒的性能与脑脊液VDRL试验相当，阳性率也相当。脑脊液TRUST - 10定性试验与脑脊液VDRL试验的符合率为98.7%。脑脊液TRUST - 10定量结果与脑脊液VDRL试验的一致性为91.4%，不一致结果不超过两个滴度。脑脊液TRUST - 17定性试验与脑脊液VDRL试验的符合率为98.1%，脑脊液TRUST - 17定量试验与脑脊液VDRL试验的符合率为87.6%。
含10μL抗原的脑脊液TRUST可作为脑脊液VDRL试验诊断神经梅毒的替代方法。我们的结果为使用TRUST指导神经梅毒诊断提供了依据。
