TPPA阳性“冠心病”患者梅毒血清试验与超声心动图研究

The Study on Serological Test of Syphilis and Echocardiography of "Coronary Artery Disease" Patients with TPPA Positive

目的分析近2年来TPPA阳性的“冠心病”患者的梅毒血清试验、心脏彩超和胸片资料,为这类患者在诊断心血管梅毒上提供思路和方法。方法对以“冠心病”相关诊断入院的心内、心外科及急诊抢救中心的TPPA阳性患者进行梅毒血清复检,并对患者进行了心脏彩超检查。结果132例TPPA阳性患者,RPR、TPHA阳性者分别47(35.61%)例,130(98.49%)例。心脏彩超检查,132例主动脉(AA)根径(32.2±4.2)mm,65例升主动脉(Aao)内径(37.9±5.1)mm,均大于正常值,并且AA根径平均值与TPPA阴性冠心病患者相比有统计学差异;主动脉瓣钙化49(37.13%)例,主动脉瓣返流52(39.40%)例,较老年性AV退行性变差异有显著性。胸片示:主动脉增宽86.61%(97/112),主动脉钙化41.08%(46/112)。RPR阳性/阴性患者的AA根径、Aao内径差异无统计学意义;但主动脉瓣钙化及返流有统计学差异。结论对不能提供相关病史的TPPA、TPHA同时阳性患者,应考虑患者既往感染过梅毒螺旋体。即使RPR阴性,且未见其他阳性体征,仅AA及Aao稍大及主动脉瓣钙化、主动脉瓣返流的冠心病患者,也应对可能潜在的梅毒性损害给予重视,并在合适时机实施规范化治疗及复查。

Objective To analyze the data of the patients diagnosed as ＂Coronary Artery Disease＂, re-test their syphilis serological test, study at their echocardiogram, x-ray film, which provide some idea and scientific basis on diagnosis such patients. Methods Request to re-test syphilis serologic test, make an echocardiogram and x-ray film. Results 132 patients were found TPPA positive for about 2 years. RPR and TPHA （ ＋ ） were 47 （ 35.61% ） and 130 （ 98.49% ）. Echocardiograms showed： aortic root inner diameter was 32.2 ±4. 2 mm（ 132 cases） ,ascending aortic inner diameter was 37.9 ±5.1 mm（68 cases） ,they were larger than normal value,aortic root inner diameter is also larger than CAD patients and the statistical difference is detected ; Aortic valve （AV） calcification is 49 （37.13%）, aortic regurgitation （AR） was 52 （ 39.40% ）. X-ray films showed that arteriae aorta widen was 86.61% （97/112）, arteriae aorta calcification was 41.08% （46/112）. No significant difference in aortic root inner diameter and ascending aortic inner diameter was detected between RPR （＋） and （-） patients, but statistical difference in Aortic valve calcification and regurgitation was detected. Conclusion Though the patients with TPPA test （positive） cannot apply their real associated histories, we cannot make a decision that the test is false-positive readily when TPHA is （positive）. And because of non-specific of the RPR test, atypical symptom of cardiovascular syphilis,if we confirm a patient who has been infected by Treponema, and his inner diameter of aortic root and ascending aortic is larger than normal, or/and with AV calcification and AR, the cardiovascular syphilis should be considered,and standard therapies should be executed sooner or later.