매독 진단을 위해 병원에서 시행하는 매독 검사에 대해 조금 자세히 알아보도록 하겠다.
매독 진단, 매독 검사는 어떻게?
매독 진단을 위한 매독 검사는 크게 두 종류가 있는데 nontreponemal test와 treponemal test 라고 한다. 매독 진단을 위해서는 이 두가지 검사가 모두 필요하다.
nontreponemal test는 매독균에 감염된 사람의 몸에서 생성되는 자가항체를 측정하는 간접 검사이고, treponemal test는 매독의 원인균인 Treponema pallidum 항원에 대한 특이적인 항체를 측정하는 보다 직접적인 검사이다.
Nontreponemal test
Nontreponemal test에는 Venereal Disease Research Laboratory (VDRL)와 Rapid Plasma Reagin (RPR)검사가 대표적이다.
RPR은 정량검사로서, 최근에는 자동화 검사장비를 이용하여 RPR latex agglutination test를 시행하는 검사실도 있다.
Treponemal test
Treponemal test에는 fluorescent treponemal antibody absorbed test (FTA-ABS), T.pallidum haemagglutination assay (TPHA), T.pallidum passive particle agglutination (TPPA), chemiluminescence immunoassay (CIA), enzyme immunoassay (EIA) 등이 있다.
매독 진단 algorithm
매독 검사의 경우, Nontreponemal test로 screening을 하고, 양성이 나올 경우 treponemal test로 확진한다는 것이 의과대학 족보였는데, 최근에는 treponemal test가 자동화되면서 검사 비용이 감소되어, nontreponemal test와 treponemal test를 동시에 측정하거나, 아예 treponemal test로 screening을 하고 nontreponemal test로 confirm을 하는 Reverse Sequence Screening Algorithm의 개념까지 등장하게 되었다.
위 기준에 의하면 treponemal test와 nontreponemal test에서 모두 양성이면 진단할 수 있다. 그렇지만, 최초 매독 진단시에는 nontreponemal test (VDRL or RPR) 중 1가지와 추가적으로 2가지 treponemal test를 통해 진단하는 것이 바람직하다. (예, RPR + FTA-ABS + CIA)
매독 검사 결과의 해석
일단 RPR이나 VDRL검사와 같은 경우 1:1, 1:2, 1:4 등으로 검사 결과가 보고되는데, 숫자가 커질수록 더 많이 희석했을 때도 양성이 나왔다는 의미이므로 더 역가가 높다(항체가 많이 있다)고 할 수 있다. 위양성인 경우는 1:4이하로 역가가 낮은 경우가 많다.
history가 없고 증상이 없는 환자의 경우에는 위의 표에 따라 해석을 하게 되는데, 애매한 경우는 B,C이다. Nontreponemal test가 음성이면서 treponemal test 중 하나에서 양성인 경우인데, 이 경우에는 환자의 역학과 임상상을 따져서 치료를 결정하면 된다. F, G인 경우에는 실제 매독 감염이 있었을 가능성이 높으므로 잠복매독으로 보고 치료하는 것이 권장된다.
함께 읽으면 좋은 글: 뇌척수액 매독 검사 (신경 매독 검사)
검사 기술이 발전하면서 족보가 바뀌네요 ㅎㅎ 흥미롭습니다
감사합니다. 앞으로 기술 발전에 따라 임상 현장에서 진단 검사법이 어떻게 바뀌어갈지 기대가 됩니다 🙂
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