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首页> 美国卫生研究院文献>Journal of Clinical Microbiology >Comparison of the Cerebrospinal Fluid (CSF) Toluidine Red Unheated Serum Test and the CSF Rapid Plasma Reagin Test with the CSF Venereal Disease Research Laboratory Test for Diagnosis of Neurosyphilis among HIV-Negative Syphilis Patients in China
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Comparison of the Cerebrospinal Fluid (CSF) Toluidine Red Unheated Serum Test and the CSF Rapid Plasma Reagin Test with the CSF Venereal Disease Research Laboratory Test for Diagnosis of Neurosyphilis among HIV-Negative Syphilis Patients in China

机译：脑脊液甲苯胺红未加热血清试验与脑脊液快速血浆凝集素试验与脑脊液静脉疾病研究实验室试验在中国HIV阴性梅毒患者中诊断神经梅毒的比较

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In this study, we aimed to investigate the performance of nontreponemal antibody tests in cerebrospinal fluid (CSF) specimens from syphilis patients. From September 2009 to September 2012, CSF specimens were collected at the Shanghai Skin Disease Hospital in Shanghai, China, from 1,132 syphilis patients without HIV infection, including 154 with symptomatic and 56 with asymptomatic neurosyphilis. All of the CSF specimens underwent testing with a rapid plasma reagin (RPR) test, an RPR-V (commercial RPR antigen diluted 1:2 in 10% saline) test, the toluidine red unheated serum test (TRUST), and the Venereal Disease Research Laboratory (VDRL) test. Specificities, sensitivities, positive predictive values (PPVs), negative predictive values (NPVs), and kappa values were calculated to determine the performances of the tests. We compared results of the CSF-VDRL, CSF-RPR, CSF-RPR-V, and CSF-TRUST among patients with symptomatic and asymptomatic neurosyphilis who had reactive CSF-Treponema pallidum particle agglutination (TPPA) test results. Overall, the CSF-VDRL test was reactive in 261 patients (23.1%). There were no cases in which the CSF-VDRL was nonreactive and CSF-RPR, CSF-RPR-V, or CSF-TRUST was reactive. Agreement between the results of CSF-TRUST and CSF-RPR was almost perfect (κ = 0.861), with substantial agreement between the results of CSF-RPR and CSF-RPR-V (κ = 0.740). The sensitivities of CSF-VDRL, CSF-RPR, CSF-RPR-V, and CSF-TRUST were 81.4%, 76.2%, 79.5%, and 76.2%, respectively. Compared to CSF-VDRL, CSF-RPR, CSF-RPR-V, and CSF-TRUST had comparable PPVs and NPVs. However, the specificity of CSF-VDRL (90.3%) was significantly lower than those of the other tests (92.7 to 93.4%). Therefore, CSF-RPR, CSF-RPR-V, and CSF-TRUST can be considered alternative tests for neurosyphilis diagnosis in HIV-negative populations, particularly when the CSF-VDRL is not available.
机译：在这项研究中，我们旨在调查梅毒患者脑脊液（CSF）标本中非四链体抗体检测的性能。从2009年9月至2012年9月，在中国上海的上海皮肤病医院收集了1132例未感染HIV的梅毒患者的CSF标本，其中包括154例有症状的梅毒和56例无症状的神经梅毒。所有的CSF标本都接受了快速血浆反应素（RPR）测试，RPR-V（在10％盐水中以1：2稀释的商业RPR抗原）测试，甲苯胺红未加热血清测试（TRUST）和性病研究实验室（VDRL）测试。计算特异性，敏感性，阳性预测值（PPV），阴性预测值（NPV）和kappa值，以确定测试的性能。我们比较了有反应性和无症状性神经梅毒的CSF-VDRL，CSF-RPR-V和CSF-TRUST的结果，这些患者有反应性CSF-梅毒螺旋体颗粒凝集（TPPA）测试结果。总体而言，CSF-VDRL测试在261例患者中有反应（23.1％）。没有CSF-VDRL不反应而CSF-RPR，CSF-RPR-V或CSF-TRUST反应的情况。 CSF-TRUST和CSF-RPR结果之间的一致性几乎是完美的（κ= 0.861），CSF-RPR和CSF-RPR-V结果之间的一致性（κ= 0.740）。 CSF-VDRL，CSF-RPR，CSF-RPR-V和CSF-TRUST的敏感性分别为81.4％，76.2％，79.5％和76.2％。与CSF-VDRL相比，CSF-RPR，CSF-RPR-V和CSF-TRUST具有可比的PPV和NPV。但是，CSF-VDRL的特异性（90.3％）明显低于其他测试的特异性（92.7％至93.4％）。因此，可以将CSF-RPR，CSF-RPR-V和CSF-TRUST视为HIV阴性人群神经梅毒诊断的替代测试，尤其是在没有CSF-VDRL的情况下。

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