不同类型神经梅毒驱梅后实验室检查指标差异分析  

Analysis the differences of laboratory indexes among different types of neurosyphilis after penicillin treatment

作　　者：师璐 黄宇明[1,2] 寇程 许东梅 SHI Lu;HUANG Yuming;KOU Cheng;XU Dongmei(Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;National Center for Infectious Disease,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院,北京100015 [2]国家传染病医学中心,北京100015

出　　处：《中国实用神经疾病杂志》2022年第7期825-831,共7页Chinese Journal of Practical Nervous Diseases

基　　金：首都医科大学附属北京地坛医院院内科研基金“启航计划”项目(编号:DTQH201607)。

摘　　要：目的探讨无症状神经梅毒、脊髓痨和麻痹性痴呆驱梅后实验室检查指标的差异及影响因素。方法收集首都医科大学附属北京地坛医院神经内科住院治疗的50例HIV阴性神经梅毒患者,其中无症状16例,脊髓痨14例,麻痹性痴呆20例。比较驱梅后3组间外周血和脑脊液(CSF)实验室检查指标,采用Logistic回归分析CSF蛋白和CSF甲苯胺红不加热血清试验(TRUST)滴度的影响因素。结果驱梅后外周血淋巴细胞(LY)及亚群多重比较,无症状患者LY总数显著大于脊髓痨和麻痹性痴呆患者,CD4^(+)T淋巴细胞计数显著大于麻痹性痴呆患者,CD8^(+)T淋巴细胞计数显著大于脊髓痨患者(P<0.05);驱梅后脊髓痨患者CSF蛋白显著高于无症状和麻痹性痴呆患者(P<0.05)。Logistic回归分析提示,驱梅后麻痹性痴呆和无症状患者CSF蛋白更倾向低于脊髓痨患者(OR=0.169,95%CI:0.033~0.875,P=0.034;OR=0.092,95%CI:0.015~0.573,P=0.011);脊髓痨和麻痹性痴呆患者CSF TRUST滴度更倾向高于无症状患者(OR=15.298,95%CI:2.070~113.077,P=0.008;OR=14.736,95%CI:2.174~99.886,P=0.006)。结论不同类型神经梅毒驱梅后实验室检查指标差异可能与免疫损伤和病理改变有关,应动态监测这类指标预测病情和预后,制定个体化精准治疗方案。Objective To investigate the differences and influencing factors of laboratory indexes among asymptomatic neurosyphilis,tabes dorsalis and general paresis after penicillin treatment.Methods Totally of 50 HIV-negative neurosyphilis patients were enrolled,who were hospitalized in the Department of Neurology,Beijing Ditan Hospital,Capital Medical University including 16 patients of asymptomatic neurosyphilis,14 patients of ta⁃bes dorsalis and 20 patients of general paresis.The differences in peripheral blood and cerebrospinal fluid(CSF)indexes after treatment were compared among the three groups,and influencing factors of CSF protein and CSF TRUST titer were analyzed by Logistic regression.Results Post hoc multiple comparisons of peripheral blood lymphocytes(LY)and their subgroups showed that the count of LY in asymptomatic neurosyphilis was significantly higher than tabes dorsalis and general paresis,while the count of CD4^(+)T lymphocytes in asymptomatic neuro⁃syphilis was significantly higher than general paresis and the count of CD8^(+)T lymphocytes in asymptomatic neuro⁃syphilis was significantly higher than tabes dorsalis(P<0.05).The CSF protein quantification of tabes dorsalis was significantly higher than asymptomatic neurosyphilis and general paresis after treatment(P<0.05).Logistic regression analysis showed that CSF protein of general paresis and asymptomatic neurosyphilis after treatment was more likely to be lower than tabes dorsalis(OR=0.169,95%CI:0.033-0.875,P=0.034;OR=0.092,95%CI:0.015-0.573,P=0.011);CSF TRUST titer of tabes dorsalis and general paresis more likely to be higher than as⁃ymptomatic neurosyphilis(OR=15.298,95%CI:2.070-113.077,P=0.008;OR=14.736,95%CI:2.174-99.886,P=0.006).Conclusion The differences in laboratory indexes among three types of neurosyphilis after penicillin treatment may be related to immune damage and pathological changes.Monitor the changes of laboratory indexes after treatment dynamically in order to predict the state and prognosis of illness,and formulate indivi

关 键 词：神经梅毒 临床分型 驱梅治疗 实验室检查指标 影响因素 

分 类 号：R759.13[医药卫生—皮肤病学与性病学]