切换至 "中华医学电子期刊资源库"

中华实验和临床感染病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (04) : 254 -260. doi: 10.3877/cma.j.issn.1674-1358.2022.04.006

论著

60例人类免疫缺陷病毒感染者/获得性免疫缺陷综合征合并神经梅毒患者临床和实验室特征
魏春波1, 万钢2, 许东梅3, 赵兴云1, 袁柳凤1, 吴焱1, 伦文辉,1   
  1. 1. 100015 北京,首都医科大学附属北京地坛医院皮肤性病科(感染病科国家临床重点专科)
    2. 100015 北京,首都医科大学附属北京地坛医院病案统计科
    3. 100015 北京,首都医科大学附属北京地坛医院神经内科
  • 收稿日期:2021-12-27 出版日期:2022-08-15
  • 通信作者: 伦文辉

Clinical and laboratory characteristics of neurosyphilis in 60 patients with human immunodeficiency virus infection/acquired immune deficiency syndrome

Chunbo Wei1, Gang Wan2, Dongmei Xu3, Xingyun Zhao1, Liufeng Yuan1, Yan Wu1, Wenhui Lun,1   

  1. 1. Department of Dermatology, the National Clinical Key Department of Infectious Diseases
    2. Department of Medical Records Statistics, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
    3. Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
  • Received:2021-12-27 Published:2022-08-15
  • Corresponding author: Wenhui Lun
引用本文:

魏春波, 万钢, 许东梅, 赵兴云, 袁柳凤, 吴焱, 伦文辉. 60例人类免疫缺陷病毒感染者/获得性免疫缺陷综合征合并神经梅毒患者临床和实验室特征[J/OL]. 中华实验和临床感染病杂志(电子版), 2022, 16(04): 254-260.

Chunbo Wei, Gang Wan, Dongmei Xu, Xingyun Zhao, Liufeng Yuan, Yan Wu, Wenhui Lun. Clinical and laboratory characteristics of neurosyphilis in 60 patients with human immunodeficiency virus infection/acquired immune deficiency syndrome[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2022, 16(04): 254-260.

目的

分析人类免疫缺陷病毒(HIV)感染者/获得性免疫缺陷综合征(AIDS)合并无症状神经梅毒(ANS)和症状性神经梅毒(SNS)患者的临床及实验室特征,并探讨SNS的危险因素。

方法

收集2014年1月至2021年8月首都医科大学附属北京地坛医院住院确诊为神经梅毒的60例HIV/AIDS患者的临床资料,采用Spearman相关分析患者CD4+ T细胞计数与脑脊液指标的相关性;并根据临床症状或体征分为ANS组(23例)和SNS组(37例),分析两组患者的临床特征、血清学及脑脊液指标,并采用多因素Logistic回归分析ANS患者进展为SNS的危险因素。

结果

入组患者均为男性,中位年龄32.5岁,SNS组驱梅治疗和抗逆转录病毒治疗(ART)者均为6例(16.22%),显著低于ANS组[18例(78.26%)和16例(69.57%)](χ2 = 22.750、P = 0.001,χ2 = 17.383、P < 0.001);CSF TRUST滴度分布差异有统计学意义(P = 0.030),SNS组CSF TRUST阳性患者29例(78.38%),显著高于ANS组[9例(39.13%)](χ2 = 8.013、P = 0.005)。入院时血清TRUST滴度分布差异有统计学意义(P = 0.026),SNS组患者入院时血清TRUST滴度[1︰128(1︰32,1︰256) vs. 1︰32(1︰8,1︰64):Z =-3.303、P = 0.001]和CSF-WBC计数[45(18.5,92)个/μl vs. 15(6,22)]个/μl:Z = -3.613、P < 0.001]均显著高于ANS组;而CSF葡萄糖浓度[2.9(2.5,3.5)mmol/L vs. 3.3(3.0,4.0)mmol/L:Z =-2.266、P = 0.023]显著低于ANS组。两组患者年龄、CSF蛋白含量、CSF蛋白异常率、CSF氯化物浓度、CD4+ T细胞计数以及CD4+ T细胞计数< 200个/μl患者比例差异均无统计学意义。CD4+ T细胞计数与脑脊液蛋白含量(r =-0.498、P < 0.001)、脑脊液葡萄糖浓度(r = 0.442、P < 0.001)、脑脊液氯化物浓度(r = 0.289、P = 0.025)均有一定相关性。多因素Logistic回归分析显示,有驱梅治疗史(OR = 0.060、P = 0.001)为ANS进展为SNS的保护性因素;入院时血清TRUST滴度(OR = 1.489、P = 0.039)、ln脑脊液白细胞计数(OR = 2.690、P = 0.007)为ANS进展为SNS的危险性因素。血清TRUST滴度每升高1个滴度,ANS进展为SNS的风险增加1.489倍;脑脊液白细胞计数每增加1个ln值,ANS进展为SNS的风险增加2.690倍。

结论

患者CD4+ T细胞计数越低,脑脊液蛋白含量越高,而脑脊液葡萄糖浓度、脑脊液氯化物浓度则越低;驱梅治疗可降低SNS发生率,血清TRUST滴度及脑脊液白细胞计数升高可能增加ANS进展为SNS的风险。

Objective

To investigate the clinical and laboratory characteristics of asymptomatic neurosyphilis (ANS) and symptomatic neurosyphilis (SNS) in patients with human immunodeficiency virus infection/acquired immune deficiency syndrome (HIV/AIDS), and to analyze the risk factors of SNS.

Methods

Total of 60 HIV/AIDS inpatients with neurosyphilis were enrolled in Beijing Ditan Hospital, Capital Medical University from January 2014 to August 2021. The correlation between CD4+ T cell count and cerebrospinal fluid (CSF)-related factors were analyzed by Spearman correlation analysis. The enrolled patients were divided into SNS group (23 cases) and ANS group (37 cases) according to clinical symptoms or signs, the clinical characteristics, serology and CSF examination were compared, respectively. The risk factors for progression to symptomatic neurosyphilis were analyzed by multivariate Logistic regression.

Results

All the 60 patients were male, with a median age of 32.5 years old. Patients who received antisyphilitic treatment or antiretroviral therapy (ART) were both 6 cases (16.22%) in SNS group, which were significantly lower than those of ANS group for 18 patients (78.26%) and 16 patients (69.57%), with significant differences (χ2 = 22.750, P = 0.001; χ2 = 17.383, P < 0.001). There was a statistical difference in CSF TRUST titer distribution (P = 0.03), and there were 29 cases (78.38%) with positive CSF TRUST in SNS group, which was significantly higher than that of ANS group [9 cases (39.13%)], with significant difference (χ2 = 8.013, P = 0.005). There was a statistical difference in serum TRUST titer distribution at admission (P = 0.023), and the serum TRUST titer, CSF-WBC count of patients in SNS group were [1︰128 (1︰32, 1︰256)] and [45 (18.5, 92)] cells/μl, which were significantly higher than those of ANS group [1︰32 (1:8, 1︰64) and 15 (6, 22) cells/μl], with significant differences (Z =-3.303, P = 0.001; Z =-3.613, P < 0.001); but the CSF glucose concentration was significantly lower than that of ANS group [2.9 (2.5, 3.5) mmol/L vs. 3.3 (3.0, 4.0) mmol/L], with significant difference (Z =-2.266, P = 0.023). Age, serum TRUST titer distribution at admission, CSF TRUST titer distribution, CSF protein concentration, CSF protein abnormal rate, CSF chloride, count of CD4+ T cells and proportion of patients with CD4+ T cells count < 200 cells/μl were all without significant differences between the two groups. CD4+ T cells counts were correlated with CSF protein concentration (r =-0.498, P < 0.001), CSF glucose concentration (r = 0.442, P < 0.001), CSF chloride concentration (r = 0.289, P = 0.025). Multivariate Logistic regression analysis showed that a history of antisyphilistic therapy (OR = 0.060, P = 0.001) was the protective factor of ANS progression to SNS; Serum TRUST titer at admission (OR = 1.489, P = 0.039) and ln CSF-WBC count (OR = 2.690, P = 0.007) were risk factors of ANS progression to SNS. The risk of ANS progression to SNS increased 1.489 times for every increase in serum TRUST titer, and 2.690 times for every ln increase in CSF WBC count.

Conclusions

The lower the count of CD4+ T cells, the higher the protein concentrations in CSF, while the lower the concentrations of glucose and chloride in CSF. Treatment with benzylpenicillin could reduce the occurrence of SNS, and the increase of current serum TRUST titer and CSF WBC count may increase the risk of asymptomatic neurosyphilis developing into symptomatic neurosyphilis.

表1 HIV/AIDS合并神经梅毒患者人口统计学资料和基线特征
临床资料 SNS组(37例) ANS组(23例) 统计量 P
年龄[M(P25、P75),岁] 30(26,38) 33(29,46) Z =-1.461 0.144a
驱梅治疗[例(%)]     χ2 = 22.750 0.001b
  6(16.22) 18(78.26)    
  31(83.78) 5(21.74)    
ART治疗[例(%)]     χ2 = 17.383 < 0.001b
  6(16.22) 16(69.57)    
  31(83.78) 7(30.43)    
入院时血清TRUST滴度[M(P25,P75)] 1︰128(1︰32,1︰256) 1︰32(1︰8,1︰64) Z =-3.303 0.001a
入院时血清TRUST滴度分布[例(%)]     0.030c
  1︰2 0(0.00) 2(8.70)    
  1︰4 1(2.70) 1(4.35)    
  1︰8 4(10.81) 5(21.74)    
  1︰16 2(5.41) 3(13.04)    
  1︰32 5(13.51) 4(17.39)    
  1︰64 1(2.70) 3(13.04)    
  1︰128 6(16.22) 2(8.70)    
  1︰256 18(48.65) 3(13.04)    
血清TPPA阳性[例(%)] 37(100.00) 23(100.00)
CSF TRUST     χ2 = 8.013 0.005b
  阳性 29(78.38) 9(39.13)    
  阴性 8(21.62) 14(60.87)    
CSF TRUST滴度分布[例(%)]        
  阴性 8(21.62) 14(60.87) 0.026c
  1︰1 7(18.92) 5(21.74)    
  1︰2 5(13.51) 1(4.35)    
  1︰4 9(24.32) 1(4.35)    
  1︰8 7(18.92) 2(8.70)    
  1︰16 1(2.70) 0(0.00)    
CSF-WBC计数[M(P25、P75),个/μl] 45(18.5,92) 15(6,22) Z =-3.613 < 0.001a
CSF蛋白含量[M(P25、P75),mg/dl] 79.6(50.1,106.3) 48.9(32.0,102.8) Z =-1.832 0.067a
CSF蛋白含量> 45 mg/dl [例(%)] 29(78.38) 13(56.52) χ2 = 3.226 0.072b
CSF TPPA阳性[例(%)] 37(100.00) 23(100.00)
CSF葡萄糖[M(P25,P75),mmol/L] 2.9(2.5,3.5) 3.3(3.0,4.0) Z =-2.266 0.023a
CSF氯化物[M(P25,P75),mmol/L] 124.1(121.1,126.5) 124.9(122.8,126.6) Z =-0.563 0.574a
CD4+ T细胞计数[M(P25,P75),个/μl] 160(70,270) 249(64,473) Z =-1.338 0.181a
CD4+ T细胞< 200个/μl [例(%)] 22(59.5) 10(43.5) χ2 = 2.000 0.157b
图1 CD4+ T细胞计数与CSF氯化物、蛋白含量及葡萄糖浓度的相关性
表2 ANS进展为SNS影响因素的Logistic回归分析
[1]
Hobbs E, Vera JH, Marks M, et al. Neurosyphilis in patients with HIV[J]. Pract Neurol,2018,18(3):211-218.
[2]
Hagihara M, Yamagishi Y, Kato H, et al. Frequency of Treponema pallidum invasion into cerebrospinal fluid in primary or secondary early-stage syphilis[J]. Infect Chemother,2018,24(5):404-406.
[3]
陈绛青,胡塔,朱冬红, 等. 江西省1 870例HIV/AIDS病人及合并HBV HCV TP感染特征分析[J]. 江西医药,2019,54(8):936-939.
[4]
Rompalo AM, Lawlor J, Seaman P, et al. Modification of syphilitic genital ulcer manifestations by coexistent HIV infection[J]. Sex Transm Dis,2001,28(8):448-454.
[5]
王千秋,刘全忠,徐金华, 等. 梅毒, 淋病和生殖道沙眼衣原体感染诊疗指南(2020年)[J]. 中华皮肤科杂志,2020,53(3):168-179.
[6]
Tuddenham S, Ghanem KG. Neurosyphilis: knowledge gaps and controversies[J]. Sex Transm Dis,2018,45(3):147-151.
[7]
Pastuszczak M, Zeman J, Jaworek AK, et al. Cerebrospinal fuid abnormalities in HIV-negative patients with secondary and early latent syphilis and serum VDRL ≥ 1︰32[J]. Indian J Dermatol,2013,58(4):325.
[8]
Klein M, Angstwurm K, Esser S, et al. German guidelines on the diagnosis and treatment of neurosyphilis[J]. Neurol Res Pract,2020,2:33.
[9]
Ropper AH. Neurosyphilis[J]. N Engl J Med,2019,381(14):1358-1363.
[10]
Farhi D, Dupin N. Management of syphilis in the HIV-infected patient: facts and controversies[J]. Clin Dermatol,2010,28(5):539-545.
[11]
Wang Z, Liu L, Shen YZ, et al. The clinical and laboratory features of neurosyphilis in HIV-infected patients: A retrospective study in 92 patients[J]. Medicine,2018,97(9):e0078.
[12]
Peeling RW, Mabey D, Kamb ML, et al. Syphilis[J]. Nat Rev Dis Primers,2017,3:17073.
[13]
French P, Gomberg M, Janier M, et al. IUSTI: 2008 European Guidelines on the Management of Syphilis[J]. Int J STD AIDS,2009,20(5):300-309.
[14]
Xiao Y, Tong ML, Liu LL, et al. Novel predictors of neurosyphilis among HIV-negative syphilis patients with neurological symptoms: an observational study[J]. BMC Infect Dis,2017,17(1):310.
[15]
Li WR, Jiang MJ, Xu DM, et al. Clinical and laboratory characteristics of symptomatic and asymptomatic neurosyphilis in HIV-negative patients: A retrospective study of 264 cases[J]. Biomed Res Int,2019:2426313.
[16]
Choe PG, Song JS, Song KH, et al. Usefulness of routine lumbar puncture in non-HIV patients with latent syphilis of unknown duration[J]. Sex Transm Infect,2010,86(1):39-40.
[17]
Xiao Y, Tong ML, Lin LR, et al. Serological response predicts normalization of cerebrospinal fluid abnormalities at six months after treatment in HIV-negative neurosyphilis patients[J]. Sci Rep,2017,7(1):9911.
[18]
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021[J]. MMWR Recomm Rep,2021,70(4):1-187.
[19]
Gonzalez H, Koralnik IJ, Marra CM. Neurosyphilis[J]. Semin Neurol,2019,39(4):448-455.
[20]
Chow F. Neurosyphilis[J]. Continuum (Minneap Minn),2021,27(4):1018-1039.
[21]
何艳群,伦文辉,许东梅. 脑脊液性病研究实验室试验和甲苯胺红不加热试验在不同类型神经梅毒检测中的一致性分析[J/CD]. 中华实验和临床感染病杂志(电子版),2021,15(4):217-222.
[22]
Smibert OC, Jenney AWJ, Spelman DW. Management of neurosyphilis: time for a new approach?[J]. Intern Med J,2018,48(2):204-206.
[23]
中华医学会感染病学分会艾滋病丙型肝炎学组,中国疾病预防控制中心. 中国艾滋病诊疗指南(2021年版)[J]. 中国艾滋病性病,2021,27(11):1182-1201.
[24]
Yu J, Shi J, Wan H, et al. Clinical characteristics, diagnosis, and predictors of neurosyphilis patients with human immunodeficiency virus co-infection: A retrospective study at infectious diseases hospitals in two cities of China[J]. Medicine (Baltimore),2021,100(42):e 27430.
[25]
de Almeida SM, Rotta I, Ribeiro CE, et al. Blood-CSF barrier and compartmentalization of CNS cellular immune response in HIV infection[J]. Neuroimmunol,2016,301:41-48.
[1] 杨桂清, 孟静静. 哺乳期亚临床乳腺炎的研究进展[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(06): 376-379.
[2] 庄燕, 戴林峰, 张海东, 陈秋华, 聂清芳. 脓毒症患者早期生存影响因素及Cox 风险预测模型构建[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(05): 372-378.
[3] 丁科, 张亚琼, 刘杰, 邓莉平, 张永喜, 熊勇. 获得性免疫缺陷综合征相关淋巴瘤患者的临床特征及生存状况的变化趋势[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(05): 278-284.
[4] 黄鸿初, 黄美容, 温丽红. 血液系统恶性肿瘤患者化疗后粒细胞缺乏感染的危险因素和风险预测模型[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(05): 285-292.
[5] 熊企秋, 邢卉春, 李宝亮, 王杨, 贾哲, 张珂, 黄容海, 蒋力. 人类免疫缺陷病毒感染对肛瘘患者接受切开挂线术治疗预后的影响[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(05): 303-308.
[6] 丁兴欢, 王小永, 李风志, 梁博, 冯恩山. 颅内外血管搭桥联合贴敷治疗慢性颈内动脉闭塞的人类免疫缺陷病毒感染者一例及文献复习[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(05): 314-319.
[7] 罗文斌, 韩玮. 胰腺癌患者首次化疗后中重度骨髓抑制的相关危险因素分析及预测模型构建[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 357-362.
[8] 贺斌, 马晋峰. 胃癌脾门淋巴结转移危险因素[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 694-699.
[9] 林凯, 潘勇, 赵高平, 杨春. 造口还纳术后切口疝的危险因素分析与预防策略[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 634-638.
[10] 杨闯, 马雪. 腹壁疝术后感染的危险因素分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 693-696.
[11] 周艳, 李盈, 周小兵, 程发辉, 何恒正. 不同类型补片联合Nissen 胃底折叠术修补食管裂孔疝的疗效及复发潜在危险因素[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(05): 528-533.
[12] 张伟伟, 陈启, 翁和语, 黄亮. 随机森林模型预测T1 期结直肠癌淋巴结转移的初步研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 389-393.
[13] 司楠, 孙洪涛. 创伤性脑损伤后肾功能障碍危险因素的研究进展[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 300-305.
[14] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
[15] 李文哲, 王毅, 崔建, 郑启航, 王靖彦, 于湘友. 新疆维吾尔自治区重症患者急性肾功能异常的危险因素分析[J/OL]. 中华卫生应急电子杂志, 2024, 10(05): 269-276.
阅读次数
全文
3
HTML PDF
最新录用 在线预览 正式出版 最新录用 在线预览 正式出版
0 0 0 0 0 3

  来源 本网站 其他网站
  次数 1 2
  比例 33% 67%

摘要
77
最新录用 在线预览 正式出版
0 0 77
  来源 本网站 其他网站
  次数 34 43
  比例 44% 56%