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中华实验和临床感染病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 328 -336. doi: 10.3877/cma.j.issn.1674-1358.2022.05.007

论著

夫妻共同感染梅毒螺旋体临床表型及实验室指标差异
师璐1, 黄宇明1, 寇程1, 秦开宇1, 吴雅丽1, 马小扬1, 许东梅1,()   
  1. 1. 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:2022-03-16 出版日期:2022-10-15
  • 通信作者: 许东梅
  • 基金资助:
    首都医科大学附属北京地坛医院院内科研基金"启航计划"项目(No. DTQH201607)

Differences of clinical phenotypes and laboratory indexes for couples co-infected with treponema pallidum

Lu Shi1, Yuming Huang1, Cheng Kou1, Kaiyu Qin1, Yali Wu1, Xiaoyang Ma1, Dongmei Xu1,()   

  1. 1. Department of Neurology, Beijing Ditan Hosipital, Capital Medical University, Beijing 100015, China
  • Received:2022-03-16 Published:2022-10-15
  • Corresponding author: Dongmei Xu
引用本文:

师璐, 黄宇明, 寇程, 秦开宇, 吴雅丽, 马小扬, 许东梅. 夫妻共同感染梅毒螺旋体临床表型及实验室指标差异[J/OL]. 中华实验和临床感染病杂志(电子版), 2022, 16(05): 328-336.

Lu Shi, Yuming Huang, Cheng Kou, Kaiyu Qin, Yali Wu, Xiaoyang Ma, Dongmei Xu. Differences of clinical phenotypes and laboratory indexes for couples co-infected with treponema pallidum[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2022, 16(05): 328-336.

目的

探讨夫妻共同感染梅毒螺旋体后临床表型及实验室指标差异。

方法

收集2015年3月至2021年7月于首都医科大学附属北京地坛医院首次诊治且人类免疫缺陷病毒(HIV)阴性的共同感染梅毒螺旋体夫妻32对。根据我国2020年梅毒和神经梅毒最新诊断标准分为症状神经梅毒(NS)-无症状NS夫妻组17对,NS-隐性梅毒夫妻组15对。分别比较两组患者夫妻间年龄、性别、外周血淋巴细胞计数和比值、梅毒血清学指标、脑脊液(CSF)白细胞(WBC)计数、蛋白(Pro)定量和葡萄糖(Glu)浓度、CSF梅毒相关指标等差异,通过条件Logistic回归分析影响夫妻间临床表型差异的因素。

结果

在症状NS-无症状NS夫妻组中,无症状NS患者T淋巴细胞计数较症状NS患者高(t =-2.184、P = 0.047),无症状NS患者CD4+ T(t =-2.088、P = 0.056)和CD8+ T(t =-2.112、P = 0.053)淋巴细胞计数高于症状NS患者,但差异无统计学意义;症状NS患者CSF TRUST滴度(Z = -2.124、P = 0.034)和CSF Pro定量(Z =-3.006、P = 0.003)高于无症状NS患者;条件Logistic回归分析显示,男性患者更易表现为症状NS(OR = 14.000、95%CI:1.841~106.465、P = 0.011)。NS-隐性梅毒夫妻组中,NS患者淋巴细胞(t = 2.322、P = 0.040)、T淋巴细胞(t = 2.385、P = 0.036)和CD8+ T淋巴细胞计数(t = 2.801、P = 0.017),CSF Pro定量(Z =-2.062、P = 0.039)及血清TRUST滴度(Z =-3.000、P = 0.003)均显著高于隐性梅毒患者;条件Logistic回归分析显示CD8+ T淋巴细胞计数高的患者更易表现为NS,但差异无统计学意义(OR = 1.008、95%CI:0.998~1.018、P = 0.130)。

结论

当夫妻双方共患NS时,男性表现为症状NS的风险高于女性,夫妻间T淋巴细胞计数,血清和CSF TRUST滴度,CSF Pro等实验室指标差异可能与机体的免疫应答和炎症反应有关。

Objective

To explore the differences of clinical phenotypes and laboratory parameters between couples after co-infection with treponema pallidum.

Methods

Total of 32 HIV-negative couples co-infected with treponema pallidum were enrolled, who were first diagnosed and treated in Beijing Ditan Hospital, Capital Medical University, from March 2015 to July 2021. These couples were divided into groups of symptomatic neurosyphilis-asymptomatic neurosyphilis (17 couples) and neurosyphilis (NS)-latent syphilis (15 couples) according to the latest diagnostic criteria for syphilis and neurosyphilis of China in 2020. The age, gender, peripheral blood lymphocyte count and ratio, serological syphilis indexes, also white blood cell (WBC) count, protein (Pro) quantification, glucose (Glu) concentration and syphilis indexes of cerebrospinal fluid (CSF)were compared between couples of the two groups, respectively. The factors affecting the differences of clinical phenotypes between couples were analyzed by Conditional Logistic Regression.

Results

In the symptomatic NS-asymptomatic NS group, the T lymphocyte count of asymptomatic NS patients was higher than that of symptomatic NS patients (t =-2.184, P = 0.047). Asymptomatic NS patients had higher CD4+ T (t =-2.088, P = 0.056) and CD8+ T (t =-2.112, P = 0.053) lymphocyte counts than those of symptomatic NS patients, but the difference was not statistically significant; the CSF TRUST titer (Z =-2.124, P = 0.034) and CSF Pro quantification (Z =-3.006, P = 0.003) of symptomatic NS patients were higher than those of asymptomatic NS patients; Conditional Logistic Regression analysis showed that male patients were more likely to present as symptomatic NS (OR = 14.000, 95%CI: 1.841-106.465, P = 0.011). In the NS-latent syphilis group, the counts of lymphocytes (t = 2.322, P = 0.040), T lymphocytes (t = 2.385, P = 0.036) and CD8+ T lymphocytes (t = 2.801, P = 0.017), CSF Pro quantification (Z =-2.062, P = 0.039) and serum TRUST titer (Z =-3.000, P = 0.003) of NS patients were significantly higher than those of latent syphilis patients; Conditional Logistic Regression analysis showed that patients with higher CD8+ T lymphocyte count were more likely to present as NS, but there was no statistical significance (OR = 1.008, 95%CI: 0.998-1.018, P = 0.130).

Conclusions

If the couple both suffer from NS, men have a higher risk to develop into symptomatic NS than women. Differences in T lymphocyte counts, serum and CSF TRUST titers, CSF Pro and other laboratory indexes between the couple may be related to the immune response and inflammatory reaction of human body.

表1 17对症状NS-无症状NS夫妻患者的一般资料
表2 15对NS-隐性梅毒夫妻患者的一般资料
表3 17对症状NS-无症状NS夫妻患者外周血淋巴细胞计数和相关比值(± s
表4 15对NS-隐性梅毒夫妻患者外周血淋巴细胞计数和相关比值(± s
表5 17对症状NS-无症状NS夫妻患者梅毒血清学指标
表6 15对NS-隐性梅毒夫妻患者梅毒血清学指标
图1 15对NS-隐性梅毒夫妻组患者梅毒血清TRUST滴度
表7 17对症状NS-无症状NS夫妻患者的CSF实验室指标
表8 15对NS-隐性梅毒夫妻组患者CSF指标[M(P25,P75)]
图2 17对症状NS-无症状NS夫妻组患者CSF TRUST滴度
表9 症状NS-无症状NS夫妻临床表现差异的影响因素(Enter法)
表10 NS-隐性梅毒夫妻临床表型差异的影响因素(Enter法)
表11 两类患者夫妻临床表型差异的影响因素(Forward:Conditional法)
[1]
Lithgow KV, Tsao E, Schovanek E, et al. Treponema pallidum disrupts VE-cadherin intercellular junctions and traverses rndothelial barriers using a cholesterol-dependent mechanism[J]. Front Microbiol,2021,12:691731.
[2]
Guo S, Guo Q. Syphilis-associated septic cardiomyopathy: case report and review of the literature[J]. BMC Infect Dis,2021,21(1):33.
[3]
Zhang RL, Wang QQ. The Treponema pallidum outer membrane protein Tp92 activates endothelial cells via the chemerin/CMKLR1 pathway[J]. Int J Med Microbiol,2020,310(3):151416.
[4]
Gonzalez H, Koralnik IJ, Marra CM. Neurosyphilis[J]. Semin Neurol,2019,39(4):448-455.
[5]
中国疾病预防控制中心性病控制中心. 梅毒,淋病和生殖道沙眼衣原体感染指南与共识诊疗指南(2020年)[J]. 中华皮肤科杂志,2020,53(3):168-179.
[6]
Haule A, Msemwa B, Mgaya E, et al. Prevalence of syphilis, neurosyphilis and associated factors in a cross-sectional analysis of HIV infected patients attending Bugando Medical Centre, Mwanza, Tanzania[J]. BMC Public Health,2020,20(1):1-12.
[7]
Abdella S, Moshago Berheto T, Tolera G, et al. Sero-prevalence of transfusion transmittable infections: HIV, hepatitis B, C and Treponema pallidum and associated factors among blood donors in Ethiopia: A retrospective study[J]. PLoS One,2020,15(10):e0241086.
[8]
许东梅,高俊华,张磊, 等. 脑脊液寡克隆区带在神经梅毒诊断中的临床意义[J/CD]. 中华实验和临床感染病杂志(电子版),2020,14(3):241-246.
[9]
Jaiswal AK, Tiwari S, Jamal SB, et al. The pan-genome of Treponema pallidum reveals differences in genome plasticity between subspecies related to venereal and non-venereal syphilis[J]. BMC Genomics,2020,21(1):1-16.
[10]
Theel ES, Katz SS, Pillay A. Molecular and direct detection tests for treponema pallidum subspecies pallidum: A review of the literature, 1964-2017[J]. Clin Infect Dis,2020,71(Suppl 1):S4-S12.
[11]
周莹莹,邓莉平,鲁植艳, 等. 获得性免疫缺陷综合征合并神经梅毒及巨细胞病毒脑炎一例并相关文献分析[J/CD]. 中华实验和临床感染病杂志(电子版),2022,15(5):350-355.
[12]
Lu Y, Ke W, Yang L, et al. Clinical prediction and diagnosis of neurosyphilis in HIV-negative patients: a case-control study[J]. BMC Infect Dis,2019,19(1):1-7.
[13]
Li W, Jiang M, Xu D, 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,2019,2019(1):1-6.
[14]
Lu S, Zheng K, Wang J, et al. Characterization of Treponema pallidum dissemination in C57BL/6 Mice[J]. Front Immunol,2020,11:577129.
[15]
Luo Y, Xie Y, Zhang W, et al. Combination of lymphocyte number and function in evaluating host immunity[J]. Aging (Albany NY),2019,11(24):12685-12707.
[16]
Cagnoni AJ, Giribaldi ML, Blidner AG, et al. Galectin-1 fosters an immunosuppressive microenvironment in colorectal cancer by reprogramming CD8(+) regulatory T cells[J]. Proc Natl Acad Sci,2021,118(21):e2102950118.
[17]
Li K, Wang C, Lu H, et al. Regulatory T cells in peripheral blood and cerebrospinal fluid of syphilis patients with and without neurological involvement[J]. PLoS Negl Trop Dis,2013,7(11):e2528.
[18]
Liu LL, Liu WN, Jiang XY, et al. Changes of T lymphocyte subsets in patients with HIV-negative symptomatic neurosyphilis[J]. Microb Pathog,2019,130:213-218.
[19]
He C, Kong Q, Shang X, et al. Clinical, laboratory and brain magnetic resonance imaging (MRI) characteristics of asymptomatic and symptomatic HIV-negative neurosyphilis patients[J]. J Infect Chemother, 2021,27(11):1596-1601.
[20]
He C, Shang X, Liu W, et al. Combination of the neutrophil to lymphocyte ratio and serum toluidine red unheated serum test titer as a predictor of neurosyphilis in HIV-negative patients[J]. Exp Ther Med,2021,21(3):185.
[21]
Asgari M, de Zelicourt DA, Kurtcuoglu V. Barrier dysfunction or drainage reduction: differentiating causes of CSF protein increase[J]. Fluids Barriers CNS,2017,14(1):1-11.
[22]
Alberto C, Deffert C, Lambeng N, et al. Intrathecal synthesis index of specific anti-treponema IgG: a new tool for the diagnosis of neurosyphilis[J]. Microbiol Spectr,2022,10(1):e01477-21.
[23]
Li XX, Zhang J, Wang ZY, et al. Increased CCL24 and CXCL7 levels in the cerebrospinal fluid of patients with neurosyphilis[J]. J ClinLab Anal,2020,34(9):e23366.
[24]
Xu DM, Cai SN, Li R, et al. Elevation of cerebrospinal fluid light and heavy neurofilament levels in symptomatic neurosyphilis[J]. Sex Transm Dis,2020,47(9):634-638.
[25]
Li W, Wu W, Chang H, et al. Cerebrospinal fluid cytokines in patients with neurosyphilis: The significance of interleukin-10 for the disease[J]. Biomed Res Int,2020,2020:3812671.
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