梅毒血清固定发病原因及相关影响因素分析

Causes and correlative factors of serum-resistance of syphilis

目的探讨引起梅毒血清固定的可能原因及相关影响因素。方法对43例梅毒血清固定患者的临床资料进行分析,对其脑脊液进行常规、生化及TRUST、TPPA、梅毒螺旋体DNA检查,同时以流式细胞仪检测外周血T细胞亚群及NK细胞了解患者细胞免疫功能情况。结果 43例血清固定患者中男性10例,女33例,男女比例为1:3.3。一期梅毒发生血清固定1例(2.3%),二期梅毒12例(27.9%),潜伏梅毒30例(69.8%)。脑脊液检查5例TPPA阳性,其中1例同时有TRUST阳性,3例梅毒螺旋体DNA阳性。梅毒血清固定患者与正常对照组相比外周血CD3+、CD8+细胞及CD4+/CD8+比值无显著性差异(P>0.05),CD4+细胞有所升高(P<0.05),而NK细胞则显著降低(P<0.001)。结论疾病早期未得到及时的诊断和治疗、无症状神经梅毒及细胞免疫失衡和免疫抑制可能是导致梅毒血清固定的重要原因。

Aim To explore the possible causes and correlative factors of serum-resistance of syphilis.Methods The clinical data of 43 patients with serum-resistance of syphilis were reviewed.Cerebrospinal fluid（CSF）routine and biochemistry,TRUST,TPPA,DNA of treponema pallidum were detected.T lymphocyte subsets and NK cell in peripheral blood of 25 patients were measured by flow cytometry to evaluate the cellular immunological function.Results There were 10 cases of male and 33 cases of female in all of 43 cases of serum-resistance of syphilis.The ratio of male to female was 1：3.3.43 patients with serum-resistance of syphilis included 1（2.3%）patient with primary syphilis,12（27.9%）patients with secondary syphilis and 30（69.8%）patients with latent syphilis.Among 43 patients CSF-TPPA was positive in 5 cases,CSF-TRUST positive in 1 case and CSF-DNA of treponema pallidum positive in 3 cases.CD3^＋,CD8^＋,and CD4^＋/CD8^＋ in peripheral blood showed no obvious differences between serum-resistance group and the healthy controls（P〉0.05）.CD4^＋ in patients were higher than that in healthy controls（P〈0.05）.NK cells in patients were obviously lower than those in healthy controls（P〈0.001）.Conclusion Delayed diagnosis and treatment,asymptomatic neurosyphilis and immune disorder may be the causes of serum-resistance of syphilis.