脑脊液异常的102例梅毒并发HIV感染患者临床分析  

Clinical analysis of 102 syphilis and HIV co-infected patients with abnormity in cerebrospinal fluid examination

作　　者：孙锡喜 许华青 刘晓璐[1] 田分[1] SUN Xi-xi;XU Hua-qing;LIU Xiao-lu;TIAN Fen(Department of Dermatovenerology,the Sixth People′s Hospital of Zhengzhou,Zhengzhou 450000,China)

机构地区：[1]郑州市第六人民医院皮肤性病科,河南郑州450000

出　　处：《临床皮肤科杂志》2020年第4期200-202,共3页Journal of Clinical Dermatology

基　　金：河南省中医药科学研究专项课题(2014ZY02085)资助项目。

摘　　要：目的:分析梅毒并发HIV感染患者的临床表现、颅脑核磁共振成像、实验室检查、治疗和预后。方法:收集该院2014年8月--2017年11月收治的102例脑脊液检查异常的梅毒患者,将其临床资料进行回顾性分析。结果:102例梅毒患者中男97例,女5例;平均发病年龄(45±3)岁。所有患者HIV初筛及确证试验均为阳性,确诊神经梅毒者51例,排除神经梅毒者51例。所有患者血清快速血浆反应素试验(RPR)及梅毒螺旋体颗粒凝集试验(TPPA)均为阳性。脑脊液检查:35例RPR阳性,98例TPPA阳性,56例梅毒螺旋体(TP)-IgM试验为阳性,29例蛋白定量升高,10例WBC计数≥1.0×10^9/L。51例确诊神经梅毒患者中,一期及二期梅毒并发HIV发展为神经梅毒患者比例为14.7%,平均时间为9个月。结论:一期或二期梅毒并发HIV患者比早期梅毒未经治疗或未治疗彻底的患者更易引起神经梅毒,脑脊液TP-IgM阳性率较高,早期梅毒并发HIV感染患者建议行脑脊液TP-IgM检查。Objective: To analyze the clinical manifestations, brain magnetic resonance imaging results, laboratory indicators,treatment efficacy and prognosis of syphilis with HIV infection. Methods: The clinical features and cerebrospinal fluid(CSF)testing results of 102 cases were reviewed and analyzed. Results: Among 102 patients with syphilis, 97 were males and 5 were females. The average age of onset was 45±3 years. Neurosyphilis was confirmed in 51 cases, and the other 51 cases were excluded. Serum RPR and TPPA were positive in all patients. CSF RPR was positive in 35 cases, and CSF TPPA was positive in 98 cases. Tp-IgM test was positive in 56 cases. Protein quantitation increased in 29 cases. White blood cell count was≥10^9/L in 10 cases. Among the 51 confirmed patients with neurosyphilis, 14.7% developed from primary/secondary syphilis combined with HIV infection, with an average duration of 9 months. Conclusion: The HIV patients with primary or secondary syphilis are more likely to develop neurosyphilis than those with untreated or unrecovered early syphilis, and Tp-IgM should detected in CSF examination for patients with early syphilis and HIV infection.

关 键 词：HIV 梅毒 神经梅毒 脑脊液 

分 类 号：R512.91[医药卫生—内科学] R759.1[医药卫生—临床医学]