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中华实验和临床感染病杂志(电子版)

中华实验和临床感染病杂志(电子版) ›› 2016, Vol. 10 ›› Issue (03) : 274 -279. doi: 10.3877/cma.j.issn.1674-1358.2016.03.005

临床论著

神经梅毒强化驱梅治疗疗效预测因素的回顾性研究
陈勇1, 张玲2, 詹永婧3, 段毓姣4, 徐艳利4, 蒋荣猛4, 李兴旺4,†()   
  1. 1. 100015　北京，首都医科大学附属北京地坛医院感染病科国家临床重点专科；075000　张家口市，河北北方学院附属第一医院感染科
    2. 100015　北京，北京大学地坛医院教学医院感染病科国家临床重点专科
    3. 100053　北京，首都医科大学宣武医院感染科
    4. 100015　北京，首都医科大学附属北京地坛医院感染病科国家临床重点专科
  • 出版日期:2016-06-15
  • 通信作者: 李兴旺
  • 基金资助:
    国家科技重大专项项目(No. 2012ZX10005010)

Retrospective study on the predictive factors of curative effect in intensive anti-syphilis therapy for neurosyphilis

Yong Chen1, Ling Zhang2, Yongjing Zhan3, Yujiao Duan4, Yanli Xu4, Rongmeng Jiang4, Xingwang Li4,†()   

  1. 1. The National Clinical Key Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China; Department of Infectious Diseases, the First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, China
    2. Department of Infectious Diseases, Beijing Ditan Hospital, Peking University Teaching Hospital, Beijing 100015, China
    3. Department of Infectious Diseases, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
    4. The National Clinical Key Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Published:2016-06-15
  • Corresponding author: Xingwang Li
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陈勇, 张玲, 詹永婧, 段毓姣, 徐艳利, 蒋荣猛, 李兴旺. 神经梅毒强化驱梅治疗疗效预测因素的回顾性研究[J]. 中华实验和临床感染病杂志(电子版), 2016, 10(03): 274-279.

Yong Chen, Ling Zhang, Yongjing Zhan, Yujiao Duan, Yanli Xu, Rongmeng Jiang, Xingwang Li. Retrospective study on the predictive factors of curative effect in intensive anti-syphilis therapy for neurosyphilis[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2016, 10(03): 274-279.

目的

探讨神经梅毒强化驱梅治疗疗效的预测因素。

方法

回顾性分析67例HIV阴性实验室确诊的神经梅毒患者的临床资料，采用Logisitic回归分析方法，分析性别、年龄、临床分型、既往驱梅治疗史、强化驱梅前血清梅毒快速血清反应试验（serum-RPR）滴度、脑脊液白细胞（CSF-WBC）计数、脑脊液蛋白（CSF-PRO）水平、脑脊液RPR（CSF-RPR）滴度等对驱梅治疗后6～12个月血清RPR滴度正常化的影响。

结果

入选的67例患者，平均年龄为（47.52 ± 11.29）岁，男︰女= 3.19︰1。在多因素Logistic回归模型中，驱梅前serum-RPR滴度、CSF-WBC计数与驱梅治疗后6～12个月serum-RPR滴度正常化呈正相关（P均< 0.05；OR = 2.449，95%CI：1.390～4.312；OR = 1.017，95%CI：1.000～1.034），而驱梅前CSF-RPR滴度与驱梅治疗后6～12个月血清RPR滴度正常化呈负相关（P均< 0.05，OR = 0.510，95%CI：0.294～0.887）。在单因素Logisitic回归分析中，强化驱梅前serum-RPR滴度和CSF-WBC计数是驱梅治疗后6～12个月serum-RPR滴度正常化的独立预测因素（P均< 0.05；OR = 1.653，95%CI：1.157～2.361；OR = 1.016，95%CI：1.000～1.032）。

结论

强化驱梅前serum-RPR滴度水平及CSF-WBC计数对强化驱梅的有效性具有一定的预测作用。而脑脊液RPR滴度，是强化驱梅治疗效果较差的预测因素。宿主的免疫状态对神经梅毒的疗效和转归可能有重要作用。

关键词: 神经梅毒, 强化驱梅治疗, 预测因素, Logistic回归分析, 回顾性研究
Objective

To investigate the predictive factors of curative effect in intensive anti-syphilis therapy for neurosyphilis.

Methods

The clinical data of 67 cases with HIV negative neurosyphilis confirmed by lab test were analyzed, retrospectively. The probably predicative factors including the age, gender, clinical categories, history of anti-syphilis treatment, serum rapid plasma regain test (serum-RPR) titer, cerebrospinal fluid (CSF) RPR titer, CSF white blood cell (WBC) count, and CSF protein level before intensive anti-syphilis therapy were measured by Logisitic regression analysis to predict the normalization of serum RPR during 6-12 month after the therapy.

Results

The average age of 67 cases which met inclusion criteria was (47.52 ± 11.29) years old. The ratio of male︰female was 3.19︰1. In the multivariate Logistic model, the serum-RPR titer, the CSF-RPR titer, and the CSF-WBC count before intensive anti-syphilis therapy were meaningful predictive factors for the normalization of serum RPR during 6-12 month after the therapy. The serum-RPR titer and the CSF-WBC count before intensive therapy were positively predictive factors for the normalization of serum RPR during 6-12 month after the therapy (P < 0.05; OR = 2.449, 95%CI: 1.390-4.312; OR = 1.017, 95%CI: 1.000-1.034), but the CSF-RPR titer was a negative predictive factor (P < 0.05; OR = 0.510, 95%CI: 0.294-0.887). Furthermore, in the univariate Logistic analysis, the serum-RPR titer and the CSF-WBC count before the therapy were independently predictive factors for the normalization of serum RPR during 6-12 month after the therapy (P < 0.05, OR = 1.653, 95%CI: 1.157-2.361; OR = 1.016, 95%CI: 1.000-1.032).

Conclusions

The serum RPR titer, and the CSF-WBC count before intensive therapy were positively predictive factors for curative effect in neurosyphilis, however, the CSF RPR titer may be a negative predictive factor for that. Moreover, the immunity mechanism of the host may play an important role in the curative effect and outcome of neurosyphilis.

Key words: Neurosyphilis, Intensive anti-syphilis therapy, Predictive factor, Logisitic regression analysis, Retrospective study
表1 神经梅毒治疗效果预测因素赋值表
预测因素 赋值
性别  
  男 1
  女 2
治疗史  
  有 1
  无 2
临床分型  
  无症状型 1
  间质型 2
  实质型 3
强化治疗前Serum-RPR滴度  
  1︰1 1
  1︰2 2
  1︰4 3
  1︰8 4
  1︰16 5
  1︰32 6
  1︰64 7
  1︰128 8
  1︰256 9
强化治疗前CSF-RPR滴度  
  1︰1 1
  1︰2 2
  1︰4 3
  1︰8 4
  1︰16 5
治疗疗效  
  有效 1
  无效 0
表2 采用进入策略筛选解释变量的结果
变量 B值 S.E.值 Wald值 P值 OR值（95%CI）
性别 0.521 0.881 0.350 0.554 1.685（0.300～9.472）
年龄 -0.008 0.028 0.075 0.784 0.992（0.939～1.049）
间质型vs无症状型 -0.448 0.818 0.300 0.584 0.639（0.129～3.172）
实质型vs无症状型 1.165 0.928 1.574 0.210 3.205（0.520～19.776）
驱梅治疗史 0.444 0.789 0.316 0.574 1.559（0.332～7.322）
serum-RPR 0.896 0.289 9.618 0.002 2.449（1.390～4.312）
CSF-WBC 0.018 0.009 3.744 0.053 1.018（1.000～1.036）
CSF-PRO -0.012 0.012 1.085 0.297 0.988（0.965～1.011）
CSF-RPR -0.654 0.352 3.450 0.063 0.520（0.261～1.037）
表3 多因素Logistic回归分析结果
变量 B值 S.E.值 Wald值 P值 OR值（95%CI）
Serum-RPR 0.772 0.250 9.540 0.002 2.165（1.326～3.534）
CSF-WBC 0.017 0.009 3.939 0.047 1.017（1.000～1.034）
CSF-RPR -0.673 0.282 5.694 0.017 0.510（0.294～0.887）
表4 预测因素的单因素Logisitic回归分析结果
变量 B值 S.E.值 Wald值 P值 OR（95%CI）
性别 0.025 0.578 0.002 0.966 1.025（0.330～3.182）
年龄 -0.013 0.022 0.355 0.551 0.987（0.945～1.031）
间质型vs无症状型 -0.270 0.546 0.245 0.621 0.763（0.262～2.224）
实质型vs无症状型 0.999 0.790 1.598 0.206 2.714（0.577～12.767)
驱梅治疗史 -0.102 0.495 0.043 0.836 0.903（0.342～2.382）
serum-RPR 0.503 0.182 7.630 0.006 1.653（1.157～2.361）
CSF-WBC 0.016 0.008 3.904 0.048 1.016（1.000～1.032）
CSF-PRO -0.007 0.008 0.813 0.367 0.993（0.997～1.009）
CSF-RPR -0.011 0.194 0.003 0.956 0.989（0.677～1.446）
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