疑似神经梅毒患者脑脊液实验室检查指标分析  

Analysis of laboratory examination results of cerebrospinal fluid in suspected neurosyphilis patients

作　　者：李宇[1] 娄金丽[1] 刘意[1] 冯霞[1] 魏虹娟[1] 孙丽梅[1] Li Yu;Lou Jinli;Liu Yi;Feng Xia;Wei Hongjuan;Sun Limei(Department of Clinical Laboratory,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院临床检验中心,100069

出　　处：《北京医学》2020年第6期500-503,共4页Beijing Medical Journal

基　　金：佑安肝病艾滋病基金-2018年度院内中青年人才孵育项目(YNKTQN20180210);“十三五”国家科技重大专项(2018ZX10721102)。

摘　　要：目的探讨脑脊液(cerebrospinal fluid,CSF)中白细胞计数、蛋白质含量、梅毒血清学检测在神经梅毒诊断中的应用价值。方法选取2015年1月至2019年12月首都医科大学附属北京佑安医院收治的疑似神经梅毒患者629例,按照神经梅毒的诊断标准分为神经梅毒组(101例)和非神经梅毒组(528例),采集CSF进行脑脊液白细胞计数(white blood cell count,CSF-WBC)、脑脊液蛋白质定量(CSF-protein)及脑脊液梅毒血清学检测[快速血浆反应素试验(rapid plasma reagent test,RPR)、梅毒螺旋体颗粒凝集试验(treponema pallidum particle agglutination,TPPA)、梅毒荧光密螺旋体抗体吸收试验(fluorescent treponema pallidum antibody absorption test,FTA-ABS)],分析上述指标在神经梅毒诊断中的应用价值。结果629例患者CSF-WBC、CSF-protein、脑脊液RPR、TPPA、FTA-ABS敏感性分别为88.12%、14.85%、87.13%、98.02%、95.05%,特异性分别为87.50%、99.43%、90.91%、42.05%、39.39%。ROC分析,脑脊液RPR、WBC和CSF-protein的AUC分别为0.904、0.931、0.813、CSF-WBC的最佳诊断界值为10.5×106/L,CSF-protein最佳诊断界值为208.36 mg/L。结论CSF-WBC、CSF-protein、脑脊液RPR对神经梅毒的诊断有重要价值,脑脊液TPPA、FTA-ABS阴性结果可排除神经梅毒,降低CSF-protein诊断界值可提高其诊断效能。Objective To analyze the value of laboratory examination results of cerebrospinal fluid in the diagnosis of neurosyphilis.Methods A total of 629 cases of suspected neurosyphilis in Beijing Youan Hospital from January 2015 to December 2019 were recruited and divided into neurosyphilis group(101 cases)and nonneurosyphilis group(528 cases).CSF was collected for white blood cell count(CSF-WBC),CSF protein,rapid plasma reagent test(RPR),treponema pallidum particle agglutination(TPPA),and fluorescent treponema pallidum antibody absorption test(FTA-ABS).Diagnostic efficacy and the best diagnostic threshold of these indicators in neurosyphilis were analyzed.Results The sensitivity of CSF-WBC,CSF protein,CSF-RPR,TPPA and FTA-ABS were 88.12%,14.85%,87.13%,98.02%and 95.05%,and the specificity was 87.50%,99.43%,90.91%,42.05%and 39.39%.The area under the curve of RPR,WBC and CSF protein was 0.904,0.931,0.813.The best diagnostic threshold of CSF-WBC was 10.5×106/L,and the best diagnostic threshold of CSF protein was less than208.36 mg/L.Conclusions CSF-WBC,CSF protein and CSF-RPR are of great value in the diagnosis of neurosyphilis.Reducing the diagnostic threshold of CSF protein can improve its diagnostic efficiency.CSF-WBC,CSF protein,CSF-RPR have important value to the diagnosis of neurosyphilis.The negative results of CSF-TPPA and FTA-ABS can exclude neurosyphilis,and reducing the diagnostic threshold of CSF protein can improve its diagnostic efficiency.

关 键 词：神经梅毒 脑脊液 快速血浆反应素试验 梅毒螺旋体颗粒凝集试验 梅毒荧光密螺旋体抗体吸收试验 

分 类 号：R759.1[医药卫生—皮肤病学与性病学] R446.14[医药卫生—临床医学]