發(fā)布時(shí)間：2018-06-17 11:18

  本文選題：上海市 + 臨床��； 參考：《復(fù)旦大學(xué)》2010年碩士論文

【摘要】：梅毒是由梅毒螺旋體引起的一種慢性疾病,它主要是通過(guò)性接觸進(jìn)行傳播。近幾年來(lái),梅毒的發(fā)病率逐年增高已經(jīng)成為一個(gè)嚴(yán)重的社會(huì)問(wèn)題。 梅毒的診斷主要依靠病史,臨床癥狀和實(shí)驗(yàn)室檢查。實(shí)驗(yàn)室檢查是梅毒診斷的重要指標(biāo),其結(jié)果的可靠性直接影響梅毒診斷,治療及療效的判定,關(guān)系到病人的生命健康,因此提高檢驗(yàn)結(jié)果的準(zhǔn)確性十分重要。 血清學(xué)實(shí)驗(yàn)是診斷梅毒的主要手段。一類(lèi)是以快速血漿試驗(yàn)(RPR)或甲苯胺紅不加熱血清試驗(yàn)(TRUST)為代表的非梅毒螺旋體實(shí)驗(yàn),通常稱(chēng)篩查試驗(yàn)；一類(lèi)是以梅毒螺旋體明膠凝集實(shí)驗(yàn)(TPPA)為代表的梅毒螺旋體特異性試驗(yàn),稱(chēng)確診試驗(yàn)。 目前尚未有對(duì)上海市梅毒血清學(xué)檢測(cè)情況的分析或報(bào)道。本研究針對(duì)上海市開(kāi)展梅毒血清學(xué)檢測(cè)的臨床實(shí)驗(yàn)室進(jìn)行評(píng)估,了解上海市梅毒血清學(xué)檢測(cè)的質(zhì)量情況,尋找影響質(zhì)量的原因并對(duì)臨床實(shí)驗(yàn)室進(jìn)行干預(yù),以提高上海市梅毒血清學(xué)檢測(cè)質(zhì)量。 第一部分 上海市59家三級(jí)醫(yī)院和區(qū)中心醫(yī)院梅毒血清學(xué)篩查試驗(yàn)檢測(cè)情況分析 目的了解上海市59家三級(jí)和區(qū)中心醫(yī)院臨床實(shí)驗(yàn)室梅毒血清學(xué)篩查試驗(yàn)檢測(cè)情況,分析影響梅毒血清學(xué)篩查試驗(yàn)檢測(cè)質(zhì)量的因素。方法2004年10月對(duì)上海市59家三級(jí)和區(qū)中心醫(yī)院實(shí)驗(yàn)室進(jìn)行現(xiàn)場(chǎng)調(diào)查,發(fā)放梅毒血清質(zhì)控樣品進(jìn)行檢測(cè)。對(duì)調(diào)查結(jié)果進(jìn)行分析,尋找影響梅毒篩查試驗(yàn)檢測(cè)質(zhì)量因素。結(jié)果59家醫(yī)院總體合格率為89.8%,梅毒篩查使用的儀器僅有40家(67.8%)合格,試劑48(98%)家單位合格,人員也都符合標(biāo)準(zhǔn)。篩查試驗(yàn)對(duì)于高滴度標(biāo)本,不同的試劑測(cè)定的篩查結(jié)果(滴度)有差異F=4.498,p=0.038。合格的儀器能提高樣品檢測(cè)的準(zhǔn)確性,x2=7.11 p=0.03。結(jié)論上海市59家三級(jí)和區(qū)中心醫(yī)院梅毒篩查試驗(yàn)總體情況良好。高滴度標(biāo)本使用不同的試劑檢測(cè)時(shí)可能會(huì)得到不同的結(jié)果,儀器是否合格也是影響樣品檢測(cè)結(jié)果是否準(zhǔn)確的重要因素之一。 第二部分 上海市臨床實(shí)驗(yàn)室梅毒血清學(xué)檢測(cè)質(zhì)量的評(píng)估 目的了解上海市臨床實(shí)驗(yàn)室梅毒血清學(xué)檢測(cè)的整體質(zhì)量,并對(duì)影響檢測(cè)的因素進(jìn)行干預(yù),以提高上海市梅毒血清學(xué)檢測(cè)的整體水平。方法2006通過(guò)發(fā)放梅毒質(zhì)控樣品,了解整體情況。2006到2007年間對(duì)上海市臨床實(shí)驗(yàn)室進(jìn)行干預(yù),比較干預(yù)前后血清學(xué)檢測(cè)的情況,評(píng)價(jià)干預(yù)的效果。結(jié)果上海市篩查試驗(yàn)3年的實(shí)驗(yàn)室合格率分別為73%、83.1%、85.2%,確診試驗(yàn)為93.5%、95.4%、99.1%。篩查試驗(yàn)中,一級(jí)醫(yī)院經(jīng)過(guò)第一次干預(yù)后合格率均有所提高x2=5.517 p=0.019,二級(jí)醫(yī)院經(jīng)第二次干預(yù)后合格率有所提高,x2=5.411 p=0.020；第一次干預(yù)后醫(yī)院的總體合格率有提高x2=0.958 p=0.010。確診實(shí)驗(yàn)檢測(cè)情況中,經(jīng)過(guò)兩次干預(yù)醫(yī)院合格率無(wú)明顯變化,p=0.065,p=0.550。3年評(píng)估顯示,確診試驗(yàn)的醫(yī)院合格率均高于篩查試驗(yàn)p=0.000。從質(zhì)控樣品分析,在陰性樣品通過(guò)第一次干預(yù)合格率有所提高p=0.000,低滴度樣品在第二次干預(yù)后出現(xiàn)合格率提高p=0.000。結(jié)論上海市臨床實(shí)驗(yàn)室梅毒檢測(cè)質(zhì)量總體情況尚可,梅毒的確診試驗(yàn)的檢測(cè)質(zhì)量要高于梅毒的篩查試驗(yàn)。目前梅毒的篩查試驗(yàn)檢測(cè)仍存在問(wèn)題,特別是對(duì)于滴度的判斷。對(duì)梅毒影響因素的干預(yù)能在一定程度上提高梅毒血清學(xué)的檢測(cè)質(zhì)量。
[Abstract]:Syphilis is a chronic disease caused by Treponema pallidum, which is mainly transmitted through sexual contact. In recent years, the increasing incidence of syphilis has become a serious social problem.
The diagnosis of syphilis mainly depends on the history, clinical symptoms and laboratory tests. Laboratory examination is an important indicator of syphilis diagnosis. The reliability of the results is directly affected by the diagnosis of syphilis, the treatment and the judgment of the curative effect are related to the life and health of the patients. Therefore, it is very important to improve the accuracy of the test results.
Serological tests are the main means for the diagnosis of syphilis. One is a non syphilis spirals test represented by rapid plasma test (RPR) or toluidine red unheated sera test (TRUST), usually called screening test, and a type of Treponema pallidum specificity test, represented by the Treponema pallidum gelatin agglutination test (TPPA), is called the diagnosis test.
At present, there is no analysis or report on the serological detection of syphilis in Shanghai. In this study, the clinical laboratory of syphilis detection in Shanghai was evaluated, the quality of syphilis detection in Shanghai was understood, the causes of the quality were found and the clinical laboratory was intervened to improve the syphilis sera in Shanghai. Study the quality of the test.
Part one
Analysis of Syphilis Serological Screening test in 59 hospitals of three grade and Central District in Shanghai
Objective to understand the screening test of Syphilis Serological Screening test in clinical laboratories of 59 three grade and district central hospitals in Shanghai, and to analyze the factors affecting the quality of serological screening test for syphilis. Methods in October 2004, a field investigation was carried out on the laboratory of 59 central hospitals in Shanghai, Shanghai, and the quality control samples of syphilis were detected. The results were analyzed to find the quality factors affecting the screening test of syphilis. The total qualified rate of the 59 hospitals was 89.8%, only 40 (67.8%) were qualified for the screening of syphilis, 48 (98%) of the reagents were qualified and the personnel were all conformed to the standard. The screening test for the high titer specimens, the screening results of different reagents (titers) There is a difference of F=4.498, p=0.038. qualified instrument can improve the accuracy of sample detection, x2=7.11 p=0.03. conclusion the total situation of syphilis screening test in 59 Shanghai three grade and District Central Hospital is good. The high titer specimen may get different results when using different reagents. One of the important factors of accuracy.
The second part
Evaluation of Syphilis Serological detection quality in Shanghai clinical laboratory
Objective to understand the overall quality of the serological examination of syphilis in Shanghai clinical laboratory and to intervene the factors affecting the detection in order to improve the overall level of Syphilis Serological Detection in Shanghai. Method 2006 through the distribution of the quality control samples of syphilis in Shanghai, the overall situation.2006 was intervened in the clinical laboratory in Shanghai and the intervention was compared. After 3 years of Shanghai screening test, the qualified rate of the laboratory was 73%, 83.1%, 85.2%, and the confirmed test was 93.5%, 95.4%. The first grade hospital had improved the qualified rate of x2 =5.517 p=0.019 after the first dry prognosis, and the two grade hospital was qualified after second times of dry prognosis. There were some improvement, x2=5.411 p=0.020; the overall qualified rate of the first hospital prognosis was higher than that of the x2=0.958 p=0.010. diagnosis test, and there was no obvious change in the qualified rate of the two intervention hospitals. The p=0.065, p=0.550.3 year evaluation showed that the qualified rate of the confirmed test was higher than the screening test p=0.000. from the quality control sample analysis. The sex sample was improved by the first intervention rate of p=0.000, the low titer samples increased p=0.000. after the second intervention. Conclusion the overall situation of the quality of syphilis detection in Shanghai clinical laboratory was still available. The quality of the diagnosis test of syphilis was higher than that of the screening test of syphilis. In particular, the intervention of factors affecting syphilis can improve the quality of syphilis serology.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2010
【分類(lèi)號(hào)】：R759.1

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