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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) ›› 2019, Vol. 13 ›› Issue (02) : 134 -139. doi: 10.3877/cma.j.issn.1674-1358.2019.02.009

所属专题： 文献；

论著

症状性神经梅毒患者强化驱梅治疗前后临床和实验室特征
钱芳1, 王爱彬1, 田地1, 徐艳利1, 宋蕊1, 蒋荣猛1, 陈志海1,†()   
  1. 1. 100015　北京，首都医科大学附属北京地坛医院感染性疾病诊疗中心、感染病科国家临床重点专科
  • 收稿日期:2018-08-13 出版日期:2019-04-15
  • 通信作者: 陈志海
  • 基金资助:
    国家科技重大专项(No. 2018ZX09711003)

Clinical and laboratory characteristics of patients with symptomatic neurosyphilis before and after intensive anti-syphilis treatment

Fang Qian1, Aibin Wang1, Di Tian1, Yanli Xu1, Rui Song1, Rongmeng Jiang1, Zhihai Chen1,†()   

  1. 1. Department of Infectious Diseases, National Clinical Key Specialty for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2018-08-13 Published:2019-04-15
  • Corresponding author: Zhihai Chen
  • About author:
    Corresponding author: Chen Zhihai, Email:
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钱芳, 王爱彬, 田地, 徐艳利, 宋蕊, 蒋荣猛, 陈志海. 症状性神经梅毒患者强化驱梅治疗前后临床和实验室特征[J]. 中华实验和临床感染病杂志(电子版), 2019, 13(02): 134-139.

Fang Qian, Aibin Wang, Di Tian, Yanli Xu, Rui Song, Rongmeng Jiang, Zhihai Chen. Clinical and laboratory characteristics of patients with symptomatic neurosyphilis before and after intensive anti-syphilis treatment[J]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2019, 13(02): 134-139.

目的

分析症状性神经梅毒患者强化驱梅治疗前后临床特征和实验室指标变化，及其对疗效评估的意义。

方法

回顾性分析于首都医科大学附属北京地坛医院住院治疗的29例HIV阴性症状性神经梅毒患者的临床资料。对患者治疗前及治疗结束6个月的血清和脑脊液（CSF）进行甲苯胺红不加热血清试验（TRUST）和梅毒螺旋体明胶颗粒凝集试验（TPPA）。观察血清TRUST（serum-TRUST）和脑脊液中白细胞计数（CSF-WBC）（× 106/L）、脑脊液蛋白水平（CSF-PRO）（mg/dl）以及CSF-TRUST动态变化，分析以上指标的临床意义及对疗效的评估价值。

结果

经强化驱梅治疗，于结束治疗6个月时serum-TRUST下降≥ 4倍的患者8例（27.58%），结束治疗2年后增加至15例（51.72%）。治疗前、结束治疗6个月及2年的患者log2serum-TRUST倒数中位数（四分位数）分别为1.81（1.20，2.11）、1.51（1.20，1.81）和1.20（0.90，1.51），两两比较差异均有统计学意义（P均< 0.001）。治疗结束6个月时CSF-TRUST滴度下降≥ 4倍或阴转的患者共17例（62.97%）；治疗前及治疗结束6个月时患者log2CSF-TRUST倒数中位数（四分位数）分别为0.60（0.30，0.90）和0.30（0.00，0.60），差异有统计学意义（Z =－3.012、P = 0.003）。治疗前及治疗结束6个月时患者CSF-PRO中位数（四分位数）分别为64.50（52.05，88.55）和50.85（37.28，65.25），差异有统计学意义（Z =－3.238、P = 0.001）。

结论

强化驱梅治疗前后CSF-PRO和CSF-TRUST滴度可用来评估神经梅毒患者的疗效；serum-TRUST滴度下降≥ 4倍可预测神经梅毒患者的疗效。

关键词: 症状性神经梅毒, 强化驱梅治疗, 实验室特征
Objective

To analyze the clinical characterisitcs and laboratory indexes of patients with symptomatic neurosyphilis before and after intensive anti-syphilis therapy, and its significance for curative effect evaluation.

Methods

Data of 29 patients with HIV-negative symptomatic neurosyphilis in Beijing Ditan Hospital, Capital Medical University were analyzed, retrospectively. Serum and cerebrospinal fluid (CSF) were detected by toluidine red unheated serum test (TRUST) and treponema pallidum particle agglutination test (TPPA) before treatment and 6 months after treatment. The levels of serum TRUST (serum-TRUST), white blood cell count in CSF (CSF-WBC) (× 106/L), cerebrospinal fluid protein level in CSF (CSF-PRO) (mg/dl) and dynamic changes of CSF-TRUST were detected, respectively. The clinical significance and evaluation value of curative effect of the above indicators were analyzed.

Results

There were 8 cases (27.58%) with serum-TRUST decreased more than 4 times after 6 months intensive anti-syphilis treatment, which were 15 cases (51.72%) 2 years after treatment. Before treatment, 6 months after treatment and 2 years after treatment, the median (quartile) of log2serum-TRUST countdown were 1.81 (1.20, 2.11), 1.51 (1.20, 1.81) and 1.20 (0.90, 1.51), respectively, the differences between every two groups were significant (all P < 0.001). There were 17 patients (62.97%) with CSF-TRUST titers decreased more than 4 times or negative at the end of 6 months after treatment. Before treatment and 6 months after treatment, the median (quartile) of log2serum-TRUST countdown were 0.60 (0.30, 0.90) and 0.30 (0.00, 0.60), respectively, with significant difference (Z = -3.012, P = 0.003). Before treatment and 6 months after treatment, the median (quartile) of CSF-PRO were 64.50 (52.05, 88.55) and 50.85 (37.28, 65.25), respectively, with significant difference (Z =-3.238, P = 0.001).

Conclusions

Titers of CSF-PRO and CSF-TRUST before and after treatment could be used to evaluate the curative effect of patients with neurosyphilis, and the decrease of serum-TRUST titer ≥ 4 times could predict the curative effect of patients with neurosyphilis.

Key words: Symptomatic neurosyphilis, Intensive anti-syphilis therapy, Clinical and laboratory characteristics
表1 27例HIV阴性的神经梅毒患者强化驱梅治疗前后脑脊液相关指标[中位数（四分位数）]
指标 治疗前 治疗结束6个月 Z值 P值
CSF-WBCa,b 10.00（6.00，45.00） 5.50（3.00，10.00） －0.318 0.751
CSF-PROa,b 64.50（52.05，88.55） 50.85（37.28，65.25） －3.238 0.001
log2CSF-TRUSTa,c 0.60（0.30，0.90） 0.30（0.00，0.60） －3.012 0.003
表2 29例HIV阴性的神经梅毒患者强化驱梅治疗前后的临床表现[例（%）]
临床表现 治疗前（29例） 治疗后症状减轻（16例）
脑脊膜梅毒 4（13.8） 3（18.8）
头痛 4（13.8） 3（18.8）
头晕 3（10.3） 1（6.3）
脑膜刺激征 1（3.4） 1（6.3）
眼梅毒 2（6.9） 2（12.5）
视物模糊 2（6.9） 2（12.5）
复视 1（3.4） 1（6.3）
麻痹性痴呆 19（65.5） 10（63.0）
反应迟钝 11（37.9） 9（31.3）
言语障碍 6（20.7） 5（26.3）
记忆障碍 7（24.1） 2（12.5）
精神行为异常 7（24.1） 2（12.5）
脊髓痨 9（31.0）a 1（6.3）
大小便失禁 1（3.4） 1（6.3）
下肢感觉异常 4（13.8） 1（6.3）
步态蹒跚 5（17.2） 0（0.0）
表3 7例复治的HIV阴性神经梅毒患者强化驱梅治疗前后实验室指标
患者编号 CSF-WBC（/μl）a CSF-PRO（mg/dl）b CSF-TRUST倒数 serum-TRUST倒数
治疗前 治疗后6个月 治疗前 治疗后6个月 治疗前 治疗后6个月 治疗前 治疗后6个月 治疗后2年
1 2 4 58.4 64.5 1 2 16 8 8
2 50 6 52.6 20.7 8 8 32 16 4
3 6 4 52.7 39.4 2 1 16 16 16
4 8 10 87.6 50.6 16 16 256 128 128
5 20 4 64.5 85.7 2 4 128 128 128
6 0 5 46.5 9.9 2 2 64 64 16
7 11 12 64.1 66.0 4 4 64 16 16
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