Vdrl non reactive是什么意思

反應素(reagin)是對treponemal spirochete的特異性抗體，可以作用在cardiolipin antigen，產生非特異性的結合。梅毒反應素試驗(RPR)是一種以肉眼檢視非螺旋體凝絮現象之試驗，檢測與定量血清的反應素。

RPR使用carbon結合牛腦磷脂質，讓檢驗結果易於觀察；VDRL則直接觀察牛腦磷脂質與檢體反應素的作用。

RPR使用作為梅毒篩檢，對於第二期梅毒的梅毒具有相當好的敏感度，但對於初期感染敏感度不佳，在出現下疳前後用藥治療、第二期梅毒治療後、梅毒潛伏期，都有可能RPR(Non-Reactive)。輔助性的檢查，可以考慮TPPA或FTA-Abs。

接觸感染梅毒後的14-21天，無法測到免疫反應的抗體。

RPR可能得到生物偽陽性的結果：孩童疫苗注射，ANA(+)、多次輸血、肝炎病毒感染、痲瘋、Lyme、LGV、SLE、malaria、measles、mycoplasma、DM、treponema、IM、RA、TB、HIV、scarlet fever、typhus fever，因為干擾原因很多，陽性數據應該進一步使用FTA-Abs證實(TPPA比較不適合於初次感染)。

當確定陽性時，應評估過去3個月的性行為，並應停止性行為兩個月，直到治癒為止，爾後的兩年間應使用保險套，每季複查是否再發，因為會傳給胎兒，兩年內不得懷孕。如果不治療，幾年內會侵犯包括腦部的許多器官。

在懷疑中樞神經系統受到梅毒侵犯時，可以使用VDRL檢測CSF。並不瞭解是否RPR對IgM的敏感度，或試劑使用carbon carrier的干擾，對於CSF的檢體應作適當的標示，指定古老的VDRL檢驗，不應使用目前通用的RPR檢驗試劑。 STS(Sexually Transmitted Syphilis)是STD(Disease)的一種，HIV是最嚴重的STD，病人STS與HIV相關性極高，通常兩個檢驗項目一起分析。

屬於第三類法定傳染病，應通報疑似病例。

You have received a non-reactive HIV test result today. This almost always means you are not living with HIV.

Does a non-reactive result mean I definitely do not have HIV?

There is a period between the time of getting HIV and the time that an HIV test can detect HIV infection. If you have engaged in risk behaviors for HIV during the month prior to your test, you should speak to your provider about your need to be re-tested for HIV.

What actions put you at risk for HIV?

• Engaging in anal or vagnial intercourse
• Sharing drug paraphernalia like syringes and cookers, or sharing needles used for tattoos or piercings
• The use of drugs and/or alcohol can also put you at risk by making it harder for you to practice safe behavior

If you are planning to have a baby, or are pregnant:

Even if your test result is non-reactive today, testing and retesting of both the mother and the father may be indicated based on risk factors for HIV. It is important to know your HIV status because HIV can be passed to your baby during pregnancy, delivery or through breastfeeding.

A non-reactive test provides opportunities to protect yourself from getting HIV:

• Abstain - Not having sex or sharing needles, syringes or other drug injection equipment with a person who has HIV or whose HIV status you don't know is a sure way to protect yourself from HIV.
• Use a latex male condom or female condom - Condoms work very well to prevent HIV and other sexually transmitted diseases if you use them the right way, every time you have sex.
• PrEP (Pre-Exposure Prophylaxis) - A daily pill that can prevent HIV infection. PrEP is very effective at preventing HIV. Ask your provider if PrEP may be right for you.
• PEP (Post-Exposure Prophylaxis) - A medication that can protect you from HIV if you were recently exposed. If you start it within 2 hours of the exposure, it gives the best protection; if you start within 2-36 hours, it gives very good protection; between 36-72 hours it gives less protection as time passes; it is not started after 72 hours. If you think you were exposed to HIV through contact with someone who has or might have HIV, go immediately to an emergency room and ask for PEP.
• Consider your drug use - Using drugs or alcohol causes changes in awareness, attitutde, consciousness and behavior and can lower your ability to make decisions about safer sex and using clean needles and works.
• If you use needles or syringes:
  • Use new needles and equipment each time and don't share anything, including cotton or water.
  • Avoid buying needles on the street, even if they look new.
  • Expanded Syringe Access Programs: provides needles and syringes at pharmacies and other locations.
  • Syringe Access Programs: provides needles and syringes free of charge.
  • Do not share needles for ear piercing, body piercing or tattooing.

快速血浆反应素环状卡片试验（RPR）是80年代问世的非特异性梅毒血清学试验，所用抗原为标准的牛心肌脂抗原，该方法操作简便、迅速，适用于大量标本检测，目前许多血站用RPR试验对献血者进行梅毒普查。RPR试验和DF方法对一期梅毒的诊断相互配合，可早期诊断梅毒。缺点是当抗体含量过高时，易出现假阴性反应，即前带现象（prozone phenomenon），会有漏检；还易出现生物学假阳性反应。对潜伏期梅毒、神经梅毒不敏感。从临床统计数据表明，未经治疗梅毒病人血清阳性率(RPR实验)，一期梅毒阳性率为80％～85％，二期梅毒阳性率99％～100％，二期复发性梅毒血清反应阳性率也较高，可达80％～100％，二期梅毒复发越早，血清反应阳性率越高。一般有症状的三期梅毒，血清反应较初期或二期梅毒血清反应阳性率为低，平均为60％～80％，但实质性神经性梅毒如麻痹性痴呆血清反应阳性率可达98％～100％。可见各期梅毒病人血清反应阳性率常表现为一期低、二期高、三期减低的比较具有规律性改变。因而对疑诊梅毒病人必须结合病史，临床经过及病理组织检查结果，综合分析确定诊断。而不能完全根据血清反应的阳性结果诊断梅毒。
    RPR试验可以作为梅毒治疗的疗效判断标准之一。先后对同一个人的血清做两次非梅毒螺旋体试验，如果发生4倍滴度变化，等价于2倍稀释（如:从1:16到1:4，或者从1:8到1:32），则有必要考虑论证在临床上有重要的改变。对个别病人应用同一种试验方法（如:VDRL或RPR）做连续的血清学检测，最好在同一个实验室进行，VDRL和RPR都是同样有效的方法，但是，由于RPR的滴度常常比VDRL的滴度略微偏高，两种方法的定量结果不能直接比较。早期梅毒经足量规则抗梅治疗后3个月，RPR试验抗体滴度下降2个稀释度，6个月后下降4个稀释度。一期梅毒1年后RPR转为阴性，二期梅毒2年后RPR转为阴性。早期梅毒经充分治疗，应随访2～3年。治疗后第一年内每3个月复查一次，以后每半年复查一次。随访期间严密观察其RPR滴度下降与临床情况。

These are nontreponemal tests that measure IgG and IgM antibodies to lipoidal material released from damaged host cells as well as to lipids and lipoproteins produced by the treponems. Rapid Plasma Reagin Card (RPR) and Venereal Disease Research Laboratory (VDRL) tests are two examples of reagin tests used in the Serology Branch. The VDRL tests are slide microflocculation tests that use an antigen containing cardiolipin, lecithin and cholesterol. The VDRL antigen forms flocculates when combined with lipoidal antibodies in cerebrospinal fluid from syphilis patients.

RPR Card test is a macroscopic nontreponemal flocculation test that uses a modified VDRL antigen suspension containing choline chloride to eliminate the need to heat inactivate serum, ethylenediaminetetraacetic acid (EDTA) to enhance the stability of the suspension, and finely divided charcoal particles as a visualizing agent. Patient sera and controls are reacted with the RPR antigen on a circle in the test card. If sera contains antilipoidal antibodies, aggregates of antigen-antibody will be seen in the test circle (Figure 1). A nonreactive result will show as a button of non-aggregated carbon particles in the center of the circle (Figure 2).

Rapid Plasma Reagin (RPR) Test

1.The RPR card test is a non-treponemal test for the serological detection of syphilis. Either clear unhemolyzed serum or plasma from EDTA anticoagulated blood may be tested. The antigen suspension consists of carbon particles and a cardiolipin-lecithin extract of beef heart. This non-specific antigen detects reagin, an IgM or IgG immunoglobulin present in the plasma or serum of patients with syphilis and occasionally present in the serum or plasma of individuals with other acute or chronic conditions. If reagin is present it binds to the cardiolipin antigen resulting in flocculation. The carbon particles become trapped in the flocculation and appear agglutinated or as black clumps against a white background on the test card. The agglutination can be seen macroscopically. Specimens that are nonreactive, that is, do not contain reagin, have a uniform light-gray color and even particle distribution (no clumping).

2. The antigen suspension is mixed thoroughly and taken up into a small plastic dispensing vial containing a needle. The needle should be previously checked for dispensing accuracy by placing it firmly on a 1 ml pipet filled with the RPR antigen suspension. The pipet is held vertically and the number of drops delivered in 0.5 ml. is counted. The correct number of drops is 30 + or - 1 drop.

3.Reporting of results

4. Quantitative RPR Test

5. Quality Control

5. The RPR test will be positive in patients who have venereal syphilis and other treponemal diseases, such as bejel, pinta and yaws. Biological false positive (BFP) reactions may occur with cardiolipin antigen suspensions due to the presence of substances which react like reagin in the serum of persons having a variety of acute or chronic infections. BFP's may be caused by such conditions as infectious mononucleosis, pregnancy, bacterial and viral infections, SLE, myeloma, rheumatoid arthritis, lymphoma, leprosy, atypical pneumonia, malaria, etc.

6. The RPR test has high sensitivity (positive in disease) since approximately 80% of people with primary syphilis and 99% with secondary syphilis will give a positive test. It is therefore an excellent screening test. It is also easy to perform, fast and inexpensive. The test does, however, have low specificity and many other conditions as mentioned previously may give biological false positives.

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