神经梅毒临床及实验室诊断相关因素的分析  

Analysis of the factors related to clinical and laboratory diagnosis of neurosyphilis

作　　者：陈春晓[1] 蒋荣猛[2] 

机构地区：[1]杭州市萧山区第一人民医院感染科,杭州市311200 [2]首都医科大学附属北京地坛医院感染二科

出　　处：《中华实验和临床感染病杂志（电子版）》2014年第5期56-59,共4页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

摘　　要：目的分析神经梅毒诊断的临床及实验室相关因素。方法收集首都医科大学附属北京地坛医院2008至2013年住院的153例梅毒患者的临床和实验室资料,分为非神经梅毒组（85例）和神经梅毒组（68例）;比较两组患者性别、年龄、神经系统症状、血清甲苯胺红不加热血清反应素试验（TRUST）滴度、脑脊液梅毒螺旋体明胶颗粒凝集试验（TPPA）、脑脊液TRUST滴度、脑脊液压力、脑脊液细胞数和脑脊液蛋白水平的差异,分析神经梅毒诊断的相关因素。结果神经梅毒组与非神经梅毒组患者年龄、血清TRUST、脑脊液TRUST、脑脊液白细胞和脑脊液蛋白等差异具有统计学意义（P均〈0.05）;而脑脊液压力差异无统计学意义（P=0.383）。神经梅毒组的脑脊液TRUST滴度与血清TRUST滴度、脑脊液蛋白定量呈正相关关系（r=0.254、0.399,P=0.036、0.002）。将年龄、血清TRUST、脑脊液TPPA、脑脊液TRUST、脑脊液白细胞以及脑脊液蛋白等变量进行Logistics回归分析发现,脑脊液TPPA阳性、脑脊液蛋白升高和神经梅毒的诊断相关,且差异具有统计学意义（OR=9.955、27.707;95%CI：1.127～87.960、1.939～396.010,P=0.039、0.014）。结论神经梅毒脑脊液TRUST滴度与血清TRUST滴度、脑脊液蛋白呈正相关;除脑脊液TRUST阳性外,脑脊液TPPA阳性以及脑脊液蛋白异常（≥50 mg/dl）对于神经梅毒的诊断意义较大。Objective To analyze the dignose related elements of neurosyphilis in the clinical and laboratory. Methods Clinical and laboratory datas of 153 hospitalized patients with syphilis were collected in Beijing Ditan Hospital, Capital Medical Unversity during 2008-2013, which divided into non neurosyphilis group（85 cases） and neurosyphilis group（68 cases）. The two groups compared the differences in sex, age, neurological symptoms, serum tolulized red unheated serum test（serum TRUST）, cerebrospinal fluid（CSF） titer of treponemal pallidum particle agglutination（TPPA）, CSF titer of TRUST, CSF pressure, CSFwhite blood cell counts and CSF protein, respectively. The related factors in the diagnosis of neurosyphilis were analyzed. Results The age, serum titer of TRUST, CSF titer of TRUST, CSF-white blood cell counts and CSF protein of non neurosyphilis patients and the neurosyphilis patients were compared with significant differences（all P 〈0.05）; but the CSF pressure was with no significant difference（P = 0.383）. In neurosyphilis group, there were positive correlations between CSF titer of TRUST and the titer of serum TRUST titer, CSF protein（r = 0.254, 0.399; P = 0.036, 0.0022）. The CSF TPPA positive and the increasing of CSF protein levels were found associated with the diagnosis of neurosyphilis, by Logistic regression analysis in age, serum titer of TRUST, CSF TPPA, CSF titer of TRUST, CSF-white blood cell counts and CSF protein, with significance difference（OR = 9.955, 27.707; 95%CI： 1.127-87.960, 1.939-396.010, P = 0.039, 0.014）. Conclusions The CSF titer of TRUST in neurosyphilis was positively correlated with serum titer of TRUST, CSF protein. Excepting for the facor of CSF TRUST positive, the CSF TPPA positive and CSF protein abnormal（ ≥ 50 mg/dl） had significance for the diagnosis of neurosyphilis.

关 键 词：神经梅毒 甲苯胺红不加热血清反应素试验 脑脊液 诊断 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]