非梅毒螺旋体血清学试验持续阳性梅毒患者神经梅毒发生情况及影响因素分析  

Prevalence of and risk factors for neurosyphilis in syphilitic patients with persistently positive nontreponemal serological tests

作　　者：王娜[1] 蒋法兴[1] 朱文[1] 兰倩[1] 

机构地区：[1]安徽医科大学附属省立医院皮肤科,合肥230001

出　　处：《中华皮肤科杂志》2016年第5期314-317,共4页Chinese Journal of Dermatology

摘　　要：目的探讨正规治疗后非梅毒螺旋体（Tp）血清学试验持续阳性梅毒患者的神经梅毒发生情况及相关危险因素。方法回顾性分析248例正规治疗后非Tp血清学试验持续阳性梅毒患者的临床资料。用单因素分析、多因素logistic回归分析及ROC曲线法检测可用于预测神经梅毒的临床指标。结果248例患者中25例（10．1％）诊断为神经梅毒。单因素分析显示，血甲苯胺红不加热血清试验（TRuST）下降程度（r=20．663，P〈0．05）、血TRUST持续阳性滴度（z=-7．021，P〈0．05）与神经梅毒发生有关，而性别、年龄、梅毒分期、治疗方案、初次就诊时血TRUST滴度、有无神经系统症状与神经梅毒无显著相关性（均P〉0．05）。多因素logistic回归分析显示，血TRUST持续阳性滴度是神经梅毒的相关危险因素（OR=4．685，95％CI=2．552。8．601，P〈0．05）。绘制血TRUST持续阳性滴度的ROC曲线下面积为0．907，最佳临界滴度为1：8。结论正规治疗后，血清TRUST滴度对于预测神经梅毒有一定意义。Objective To investigate the prevalence of and risk factors for neurosyphilis in syphilitic patients with persistently positive nontreponemal serological tests after regular therapy. Methods Clinical data were collected from 248 syphilitic patients with persistently positive nontreponemal serological tests after regular therapy, and analyzed retrospectively. Univariate analysis, multivariate logistic regression analysis and receiver operating characteristic （ROC） curve analysis were performed to assess factors associated with neurosyphilis. Results Of the 248 patients, 25 （10.1%） were diagnosed with neurosyphilis. As univariate analysis showed, the occurrence of neurosyphilis was associated with the degree of decline in serum toluidine red unheated serum test （TRUST） titers （X2 = 20.663, P 〈 0.05） and persistent positive serum TRUST titers （Z = -7.021, P 〈 0.05 ）, but not wlth gender, age, stage of syphilis, treatment protocols, initial serum TRUST titers, or the presence or obsence of neurological symptoms （P 〉 0.05）. Multivariate logistic regression analysis revealed that persistent positive serum TRUST titers were a risk factor for neurosyphilis （OR = 4.685, 95% CI = 2.552 - 8.601, P 〈 0.05）. ROC curve analysis showed that the best cut-off point of persistent positive serum TRUST titer was 1 ： 8 for predicting neurosyphilis, with the area under the curve （AUC） being 0.907. Conclusion Serum TRUST titers are somewhat valuable for predicting neurosyphilis in syphilitic patients after regular therapy.

关 键 词：梅毒 神经梅毒 梅毒血清诊断 危险因素 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]