合并HIV感染的神经梅毒及非神经梅毒患者临床特征比较  

Comparison of clinical findings between neurosyphilis and non-neurosyphilis patients complicated with HIV

作　　者：杨慧勤[1] 何凯茵 柯迎春[1] 许飞龙 梁志伟 李凌华[1] 陈谐捷[1] YANG Huiqin;HE Kaiyin;KE Yingchun;XU Feilong;LIANG Zhiwei;LI Linghua;CHEN Xiejie(Guangzhou Eighth People's Hospital,Guangzhou Medical University,Guangzhou 510440,China)

机构地区：[1]广州医科大学附属市八医院感染病中心,广州510440

出　　处：《中国艾滋病性病》2021年第12期1418-1421,共4页Chinese Journal of Aids & STD

基　　金：广州市医学重点学科(2021-2023年)—病毒性传染病学科;国家科技部“十三五”艾滋病和病毒性肝炎等重大传染病防治课题(2017ZX10202101-003)。

摘　　要：目的对比合并HIV的神经梅毒及非神经梅毒患者临床及实验室检查结果,为提高诊断水平提供依据。方法将广州医科大学附属市八医院收治的HIV合并梅毒、进行了脑脊液检查的住院患者分为HIV合并神经梅毒组(简称神经梅毒组)与HIV合并非神经梅毒组(简称非神经梅毒组),对比分析其一般情况、症状体征、实验室检查、脑脊液检查及影像学检查结果。结果神经梅毒组患者33例,非神经梅毒组患者48例,两组在一般情况、HIV确诊时间、ART、合并感染率、血HIV-RNA阳性率、既往梅毒治疗情况的差异均无统计学意义。神经梅毒组血TRUST滴度≥1∶16的比例显著高于非神经梅毒组(78.8%vs.47.9%,P<0.05),神经梅毒组多经异性性行为感染。神经梅毒组与非神经梅毒组患者脑脊液白细胞数分别为26.5×10^(6)/L及5.5×10^(6)/L。神经梅毒组脑脊液蛋白数显著高于非神经梅毒组(786 mg/L vs.362 mg/L,P<0.05),有神经系统阳性症状体征的比例显著高于非神经梅毒组(84.8%vs.45.8%,P<0.05)。神经梅毒组36.4%的患者影像学检查有异常,分别为低密度感染灶(15.2%)、缺血梗死灶(15.2%)、脑白质病变(3.0%)、脑萎缩(3.0%)。结论与HIV合并梅毒比较,HIV合并神经梅毒患者血TRUST滴度、脑脊液白细胞数、脑脊液蛋白数、有神经系统阳性症状体征的比例更高。同时部分患者头颅影像学检查有异常。Objective To compare the clinical and laboratory results of people living with HIV who were diagnosed with neurosyphilis and non-neurosyphilis. The results will provide a basis to improve the diagnostic capacity of neurosyphilis. Methods Inpatients with HIV and syphilis tested for cerebrospinal fluid in the Guangzhou Eighth people’s Hospital, Guangzhou Medical university were divided into the HIV with neurosyphilis group(neurosyphilis group) and HIV with non-neurosyphilis group(non-neurosyphilis group). The general conditions, symptoms and signs, laboratory examination, cerebrospinal fluid examination, and imaging examination results were compared and analyzed between groups. Results There were 33 patients in the neurosyphilis group and 48 patients in the non-neurosyphilis group. There was no significant difference in general situation, HIV diagnosis time, ART treatment, co-infection rate, the positivity rate for blood HIV-RNA, and previous syphilis treatment history between the two groups. The proportion of blood TRUST titer ≥1∶16 in the neurosyphilis group was significantly higher than that in the non-neurosyphilis group(78.8% vs. 47.9%,P<0.05). The Neurosyphilis group was mostly infected by heterosexual behavior. The number of leukocytes in cerebrospinal fluid in the neurosyphilis group and non-neurosyphilis group were 26.5×10^(6)/L and 5.5×10^(6)/L, respectively.The number of cerebrospinal fluid proteins in the neurosyphilis group was significantly higher than that in a nonneurosyphilis group(786 mg/L vs. 362 mg/L, P<0.05).The proportion of positive symptoms and signs of the nervous system was significantly higher than that in the non-neurosyphilis group(84.8% vs. 45.8%, P<0.05).36.4% of patients in the neurosyphilis group had abnormal imaging examination, including low-density infection focus(15.2%) and ischemic infarction focus(15.2%). Conclusion Compared to people with HIV and syphilis, people with both HIV and neurosyphilis had a higher proportion of blood TRUST titer, cerebrospinal fluid leukocyt

关 键 词：艾滋病病毒 神经梅毒 临床特点 脑脊液 

分 类 号：R373.9[医药卫生—病原生物学]