HIV-1阳性神经梅毒患者的临床特征分析  

Clinical characteristics of HIV-1 positive neurosyphilis patients

作　　者：刘波[1] 赵涵[1] 陈志敏 李凌华[1] 黄继德 唐小平 蔡卫平[1] 郭琪 廖宝林 何浩岚 LIU Bo;ZHAO Han;CHEN Zhi-min;LI Ling-hua;HUANG Ji-de;TANG Xiao-ping;CAI Wei-ping;GUO Qi;LIAO Bao-lin;HE Hao-lan(Center of Infectious Disease,Guangzhou Eighth People's Hospital,Guangzhou Medical University,Guangzhou,Guangdong 510060;Laboratory Division,Guangzhou Eighth People's Hospital,Guangzhou Medical University,Guangzhou,Guangdong 510440;Guangzhou Institute of Infectious Disease,Guangzhou,Guangdong 510060;Laboratory of Virology,Beijing Key Laboratory of Etiology of Viral Diseases in Children,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]广州医科大学附属市八医院感染病中心,广东广州510060 [2]广州医科大学附属市八医院检验科,广东广州510440 [3]广州市传染病研究所,广东广州510060 [4]首都儿科研究所病毒学研究室,儿童病毒病原学北京重点实验室,北京100020

出　　处：《热带医学杂志》2022年第2期238-242,共5页Journal of Tropical Medicine

基　　金：广州地区艾滋病防治科普知识培训项目(2012KP087)。

摘　　要：目的总结人类免疫缺陷病毒(HIV)-1阳性神经梅毒患者的临床特征,以提高对HIV-1阳性神经梅毒的认识。方法回顾性分析2012年1月-2020年1月期间在广州医科大学附属市八医院感染病中心住院并诊断为HIV-1阳性梅毒及HIV-1阴性神经梅毒患者的临床资料。统计其血清及脑脊液(CSF)梅毒血清学测定、外周血T淋巴细胞及其亚群检测、脑脊液HIV-1 RNA载量测定、脑脊液常规及生化检查,分析各组患者各指标的差异。结果共纳入124例患者,其中54例HIV-1阳性神经梅毒患者(A组),53例HIV-1阳性非神经梅毒患者(B组)及17例HIV-1阴性神经梅毒患者(C组),A组与B组、C组年龄差异有统计学意义(Z=-2.042、-3.823,P=0.041、<0.001)。A组与B组平均CD4+T细胞数差异无统计学意义(Z=-0.664,P=0.507),A组与C组平均CD4+T细胞数差异有统计学意义(Z=-5.137,P<0.001)。A组与B组血清RPR滴度差异无统计学意义(Z=3.932,P=0.140),A组与C组血清RPR滴度差异有统计学意义(Z=7.906,P=0.019)。A组与B组脑脊液RPR滴度差异有统计学意义(Z=-5.268,P<0.001),A组与C组脑脊液RPR滴度差异无统计学意义(Z=-0.410,P=0.682)。A组与B组、C组脑脊液蛋白水平差异有统计学意义(Z=-6.754、-2.196,P<0.001、0.028)。A组与B组脑脊液白细胞计数差异有统计学意义(Z=-7.138,P<0.001)。A组与B组脑脊液HIV-1载量差异有统计学意义(Z=-2.911,P=0.004)。结论HIV-1阳性神经梅毒较HIV-1阴性神经梅毒发病年龄更小,有更高的血清RPR滴度及更高的脑脊液蛋白水平。在HIV-1/梅毒螺旋体合并感染者中,脑脊液HIV-1 RNA载量越高的患者越容易进展为神经梅毒。Objective To summarize the clinical features of human immunodeficiency virus(HIV)-1 positive neurosyphilis patients in order to improve the understanding of HIV-1 positive neurosyphilis.Methods The clinical data of HIV-1 positive syphilis patients and HIV-1 negative neurosyphilis patients admitted to the Infectious Disease Center of the Guangzhou Eighth People’s Affiliated Hospital of Guangzhou Medical University from January 2012 to January 2020 were analyzed retrospectively.The serological test of syphilis in serum and cerebrospinal fluid(CSF),the test of T lymphocyte and its subgroup inperipheral blood,the test of HIV-1 RNA load in cerebrospinal fluid,routine and biochemical test of cerebrospinal fluid were analyzed.Results A total of 124 patients were enrolled,including 54 HIV-1 positive neurosyphilis patients(Group A),53 HIV-1 positive non-neurosyphilis patients(Group B)and 17 HIV-1 negative neurosyphilis patients(Group C).The average age of Group A was significantly higher than Group B(Z=-2.042,P=0.041),and lower than group C(Z=-3.823,P<0.001).There was no significant difference in the mean CD4+T cells count between group A and group B(Z=-0.664,P=0.507).The difference of CD4+T cells count between Group A and Group C was statistically significant(Z=-5.137,P<0.001).There was no significant difference between Group A and Group B in serum RPR titer(Z=3.932,P=0.140).The serum RPR titer of Group A was significantly higher than that of Group C(Z=7.906,P=0.019).The CSF-RPR titer in Group A was significantly higher than that in Group B(Z=-5.268,P<0.001).There was no significant difference in CSF-RPR titer between Group A and Group C(Z=-0.410,P=0.682).The level of protein in CSF in Group A was significantly higher than that in Group B and Group C(Z=-6.754,-2.196,P<0.001,0.028).The white blood cell counts of CSF in Group A were significantly higher than those in Group B(Z=-7.138,P<0.001).The mean viral load of HIV-1 in Group A was significantly higher than that in Group B(Z=-2.911,P=0.004).Conclusions HIV-1 positive

关 键 词：HIV-1 神经梅毒 脑脊液 

分 类 号：R512.91[医药卫生—内科学]