RPR持续阳性梅毒患者脑脊液梅毒抗体与外周血细胞免疫的相关性研究

The Relationship Between Treponemal Antibody in CSF and Cellular Immunity in Peripheral Blood of Syphilitic Patients with Persisting RPR Positive

目的检测经过治疗但RPR持续阳性两年以上无神经损害临床表现的梅毒患者脑脊液中梅毒抗体与外周血淋巴细胞亚群,并探讨其相关性。方法应用梅毒血清学试验等方法对46例HIV阴性的这类梅毒患者的脑脊液进行梅毒抗体检测;同时应用流式细胞仪检测这些患者外周血淋巴细胞亚群,并与5例未治神经梅毒的脑脊液进行梅毒抗体检测结果和30例健康人群的外周血检测结果相对照。结果46例患者脑脊液中,有12例(27.39%)存在梅毒抗体,5例神经梅毒的脑脊液均存在梅毒抗体。患者外周血CD3+、CD4+T细胞及自然杀伤细胞与健康人群的检测结果差异无显著性(P>0.05),而CD8+T细胞明显高于对照组,差异有显著性(P<0.001);脑脊液梅毒抗体阳性和阴性梅毒患者之间,外周血淋巴细胞亚群检测结果差异无显著性(P>0.05)。结论经过治疗但RPR持续阳性梅毒患者脑脊液存在梅毒抗体,表明部分患者存在无症状神经梅毒;经过常规治疗但RPR持续阳性梅毒患者存在细胞免疫缺陷;无症状神经梅毒与外周血细胞免疫异常无明显的相关性。

Objective To detect the treponemal antibody in cerebrospinal fluid (CSF) and lymphocyte subsets in peripheral blood of syphilitic patients with persisting RPR positive more than 2 years without neurologic signs, then explore their relationship. Methods Treponemal antibody in CSF of 46 syphilitic with HIV negative were measured by syphilis serum test and compared with that of 5 neurosyphilis. Lymphocyte subsets were measured by flow cytometry (FCM) and compared with that of 30 healthy controls. Results In 46 treated syphilitic patient, treponemal antibody in CSF was detected not only in 12 cases (25.21%), but also in 5 neurosyphilis. The ratio of lymphocyte subsets revealed that CD3+, CD4+ T cells and natural killer (NK) cells showed no significant differences between the patient and healthy controls (P>0.05). CD8+ T cells in patients were significant higher than that in healthy controls (P<0.001). Lymphocyte subsets showd no significant differences between the patients with treponemal antibody in CSF positive and negative in CSF (P>0.05). Conclusion The treponemal antibody in CSF of treated patients suggests that part of them were asymptomatic neurosyphilis and with cellular immunodifeciency. There is no relationship between asymptomatic neurosyphilis and cellular immunodifeciency in peripheral blood.