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

doi:10.3877/cma.j.issn.1674-1358.2022.04.006

Abstract

Abstract:

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.

Key words: Human immunodeficiency virus, Acquired immune deficiency syndrome, CD4⁺ T cell, Cerebrospinal fluid, Asymptomatic neurosyphilis, Symptomatic neurosyphilis, Risk factor

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]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2022, 16(04): 254-260.

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References 25

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临床资料		SNS组（37例）	ANS组（23例）	统计量	P值
年龄[M（P25、P75），岁]		30（26，38）	33（29，46）	Z =－1.461	0.144^a
驱梅治疗[例（%）]				χ² = 22.750	0.001^b
	是	6（16.22）	18（78.26）
	否	31（83.78）	5（21.74）
ART治疗[例（%）]				χ² = 17.383	< 0.001^b
	是	6（16.22）	16（69.57）
	否	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	0.001^a
入院时血清TRUST滴度分布[例（%）]				—	0.030^c
	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	0.005^b
	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）	—	0.026^c
	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	< 0.001^a
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	0.067^a
CSF蛋白含量> 45 mg/dl [例（%）]		29（78.38）	13（56.52）	χ² = 3.226	0.072^b
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	0.023^a
CSF氯化物[M（P25，P75），mmol/L]		124.1（121.1，126.5）	124.9（122.8，126.6）	Z =－0.563	0.574^a
CD4⁺ T细胞计数[M（P25，P75），个/μl]		160（70，270）	249（64，473）	Z =－1.338	0.181^a
CD4⁺ T细胞< 200个/μl [例（%）]		22（59.5）	10（43.5）	χ² = 2.000	0.157^b

临床资料		SNS组（37例）	ANS组（23例）	统计量	P值
年龄[M（P25、P75），岁]		30（26，38）	33（29，46）	Z =－1.461	0.144^a
驱梅治疗[例（%）]				χ² = 22.750	0.001^b
	是	6（16.22）	18（78.26）
	否	31（83.78）	5（21.74）
ART治疗[例（%）]				χ² = 17.383	< 0.001^b
	是	6（16.22）	16（69.57）
	否	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	0.001^a
入院时血清TRUST滴度分布[例（%）]				—	0.030^c
	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	0.005^b
	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）	—	0.026^c
	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	< 0.001^a
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	0.067^a
CSF蛋白含量> 45 mg/dl [例（%）]		29（78.38）	13（56.52）	χ² = 3.226	0.072^b
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	0.023^a
CSF氯化物[M（P25，P75），mmol/L]		124.1（121.1，126.5）	124.9（122.8，126.6）	Z =－0.563	0.574^a
CD4⁺ T细胞计数[M（P25，P75），个/μl]		160（70，270）	249（64，473）	Z =－1.338	0.181^a
CD4⁺ T细胞< 200个/μl [例（%）]		22（59.5）	10（43.5）	χ² = 2.000	0.157^b

影响因素	β值	Wald χ²值	P值	OR值	95%CI
血清TRUST滴度	0.398	4.262	0.039	1.489	1.020~2.173
Ln（CSF-WBC）	0.989	7.349	0.007	2.690	1.315~5.501
驱梅治疗	－2.812	11.549	0.001	0.060	0.012~0.304
常量	－3.225	3.839	0.050	0.040	—

影响因素	β值	Wald χ²值	P值	OR值	95%CI
血清TRUST滴度	0.398	4.262	0.039	1.489	1.020~2.173
Ln（CSF-WBC）	0.989	7.349	0.007	2.690	1.315~5.501
驱梅治疗	－2.812	11.549	0.001	0.060	0.012~0.304
常量	－3.225	3.839	0.050	0.040	—

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