梅毒血清固定患者的系统受累状况

The systemic involvements in syphilis patients with sero-resistance

目的:了解梅毒血清固定患者是否存在系统受累。方法:对梅毒血清固定的患者进行脑脊液(CSF)、影像学和眼、耳、鼻、咽喉检查,同时检测患者的血液生化指标。结果:甲苯胺红不加热血清试验(TRUST)持续阳性,滴度为1:1～1:16,根据TRUST滴度高低分为两组,高滴度组(TRUST滴度≥1:8)24例,低滴度组(TRUST<1:8)30例;54例患者中有3例(5.6%)为血清复发,5例(9.3%)存在CSF常规、生化检查异常,14例CSF梅毒螺旋体颗粒凝集试验(TPPA)阳性(25.9%),3例CSF-TRUST阳性(5.6%)。高滴度组中有4例(16.7%)患者心脏彩超发现主动脉瓣返流,2例X线片检查发现股骨骨膜增生或骨皮质改变;所有患者其他系统检查未发现梅毒相关损害。结论:部分梅毒血清固定患者存在不同程度的系统受累,提示对血清固定的梅毒患者(尤其是高滴度者)应高度重视,并积极排查系统受累情况和是否血清复发,并根据检查结果进行有针对性的治疗。

Objective： To find out whether systemic involvement exists in syphilis patients with sero-resistance. Methods： The routine and biochemistry analysis of cerebrospinal fluid and blood were tested for the syphilis patients with sero-resis- tance. Meanwhile, imaging, ophthalmic and otorhinolaryngologic examinations were carried out. Results： TRUST titers were from 1：1 to 1：16 in the patients, and they were divided into two groups, the higher TRUST titer （〉11 ： 8） group （24cases） and the lower TRUST titer （〈1 ： 8） group （30cases）. Three of 54 （5.6%） cases were diagnosed as serum relapse. Abnormal find- ings of the routine and biochemistry analysis of cerebrospinal fluid were found in 5 （9.3%） patients, positive CSF-TPPA tests in 14 （25.9%） patients and positive CSF-TRUST tests in 3 （5.6%） patients. Four cases of aortic regurgitation were found by color Doppler uhrasonography, and bone lesions of 2 cases were found under X-ray in the higher TRUST titer group. Con- clusions： Various systemic involvements were found in some syphilis patients with sero-resistance. More attention should be paid to the syphilis patients with sero-resistance of high titers, and have to screen for the systemic involvement and serologic relapse, and to treat the patients found in time.