梅毒血清固定病人的脑脊液及免疫功能检测

Test of Cerebrospinal Fluid and Immunological Function in Patients with Syphilis Serum-resistance

目的探讨引起梅毒血清固定的可能原因。方法对25例经规范治疗后血清固定梅毒病人的脑脊液(CSF)进行常规、生化检测及RPR、TPPA测定,同时检测外周血细胞免疫和体液免疫功能以及内脏多器官影像学检查。所有病人均用水剂青霉素G2400万U/d静滴,连续14d,出院后继以苄星青霉素G240万U/次,1次/周,肌注,连续3次。分别于3、6个月复查血清RPR定量试验。结果本组25例病人中有11例CSF-TPPA(+),RPR均为(-),其中7例发现CSF-WBC、CSF-Pr增高。10例(40%)病人外周血IgM水平升高、C3降低,21例(84%)病人CD3+CD8+细胞有所增加、NK细胞减少。3例心脏彩超分别发现二尖瓣、三尖瓣及主动脉瓣返流。按神经梅毒治疗后所有病人血清RPR滴度未有降低。结论无症状神经梅毒和免疫异常可能是引起梅毒病人血清固定的原因。

Objective To explore the possible causes that result in serum-resistance of patients with syphilis. Methods Cerebrospinal fluid(CSF) routine and biochemistry, RPR, TPPA, and immunological function in 25 patients with syphilis serum-resistance were detected after giving the standard therapy, and radiographic examination of multiple internal organs was performed as well. All patients were treated with 24 million units of Penicillin G per day by intravenous drip for 14 days followed by muscle injection of Bicillin 2.4 million units weekly for 3 weeks after leaving hospital. Blood serum RPR was reexamined 3 and 6 months after treatment, respectively. Results Among 25 patients CSF-TPPA was positive in 11 cases, all patients' CSF-RPR were negative, CSF-WBC and CSF-Pr increased in 7 patients, serum IgM level increased and C3 decreased in 10 cases (40%), and CD_3+CD_8+ cell count increased and NK cell count decreased in 21 cases (84%). The regurgitation of bicuspid valve, tricuspid valve and aortic value was found in 3 patients. The RPR titers in all patients did not decrease after treatment according to neurosyphlis. Conclusion Asymptomatic neurosyphilis and immune disorder may be causes of serum-resistance of syphilis.