脑脊液实验室检测指标在神经梅毒诊断中的临床意义  

Clinical significance of laboratory detection index of cerebrospinal fluid in the diagnosis of neurosyphilis

作　　者：李道静 穆玄玄 郑旭 戴媛媛 LI Daojing;MU Xuanxuan;ZHENG Xu;DAI Yuanyuan(Department of Clinical Laboratory,the First Affiliated Hospital of University of Science and Technology of China,Core Unit of National Clinical Research Center for Laboratory Medicine,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院检验科,国家医学检验临床医学研究中心核心单位,安徽合肥230001

出　　处：《安徽医学》2023年第8期914-917,共4页Anhui Medical Journal

基　　金：安徽省自然科学基金面上项目(编号:1908085MH264)。

摘　　要：目的 统计分析梅毒患者脑脊液标本的实验室检测结果,探讨其在神经梅毒诊断中的临床意义。方法 回顾性分析中国科学技术大学附属第一医院2020年3月至2022年2月收治的121例人类免疫缺陷病毒(HIV)阴性梅毒患者脑脊液标本相关资料,对患者脑脊液标本进行梅毒螺旋体特异性抗体明胶凝集试验(TPPA)、甲苯胺红不加热血清试验(TRUST)、脑脊液免疫球蛋白IgG、IgA、IgM、脑脊液白细胞计数和脑脊液生化检测,并将结果进行统计分析;绘制受试者工作特征(ROC)曲线,探讨脑脊液实验室检测指标对神经梅毒的诊断价值。结果 在121例梅毒患者中,58例被确诊为神经梅毒。该58例患者脑脊液TPPA均阳性,其中TRUST阳性29例(50.0%),白细胞升高49例(84.5%)、蛋白升高35例(60.3%)、免疫球蛋白IgG升高56例(96.6%)、IgA升高32例(55.2%)、IgM升高41例(70.7%)。与非神经梅毒患者相比,神经梅毒患者脑脊液白细胞计数、生化蛋白及免疫球蛋白均明显升高(P<0.05)。ROC曲线结果显示,脑脊液免疫球蛋白IgG诊断神经梅毒的曲线下面积最大,诊断效能最高,其次为脑脊液白细胞计数、IgM、生化蛋白和IgA。结论 脑脊液免疫球蛋白在神经梅毒诊断中起重要作用,尤其是脑脊液TRUST阴性的神经梅毒患者,脑脊液白细胞计数、生化蛋白和免疫球蛋白的检测则可以作为神经梅毒的辅助诊断指标。Objective To statistically analyze the laboratory detection results of cerebrospinal fluids(CSF)in syphilitic patients,and explore the clinical significance of laboratory detection for the diagnosis of neurosyphilis.Methods A total of 121 syphilitic patients admitted to the First Affiliated Hospital of USTC from March 2020 to February 2022 were detected negative for HIV.The CSF samples were subjected to treponema pallidum particle assay(TPPA),tolulized red unheated serum test(TRUST),and immunoglobulin IgG,immunoglobulin IgA,immunoglobulin IgM,white blood cell(WBC)count and biochemical markers were statistically analyzed.Receiver operating characteristic curve was drawn to evaluate the diagnostic value of CSF in neurosyphilis.Results A total of 58 cases were diagnosed with neurosyphilis in 121 syphilitic patients.In these 58 cases,all cases were TPPA positive,29 cases were TRUST positive(50.0%),CSF-WBC count were elevated in 49 cases(84.5%),CSF-protein was raised in 35 cases(60.3%),CSF-IgG rose in 56 cases(96.6%),CSF-IgA was up-regulated in 32 cases(55.2%),and CSF-IgM was elevated in 41 cases(70.7%).Compared with the non-neurosyphilis group,the WBC count,protein,and immunoglobulin in CSF of neurosyphilis group were significantly increased,and the difference was statistically significant(P<0.05).ROC curve showed that the area under the curve of CSF IgG was the largest,followed by the CSF-WBC,CSF-IgM,CSF-protein and CSF-IgA.Conclusions CSF immunoglobulin play an important role in the diagnosis of neurosyphilis,especially for neurosyphilis patients with negative CSF-TRUST.CSF-WBC count,CSF-protein and CSF-immunoglobulin can be used as assistant indicators for the diagnosis of neurosyphilis.

关 键 词：脑脊液检查 神经梅毒 实验室检测 免疫球蛋白 

分 类 号：R759.13[医药卫生—皮肤病学与性病学] R446.14[医药卫生—临床医学]