驱梅治疗后血清TRUST滴度不降的梅毒患者的脑脊液CXCL13检测结果分析

The cerebrospinal fluid concentrations of CXCL13 in syphilis whose TRUST titers failed to decline after therapy

目的对驱梅治疗半年后,梅毒甲苯胺红不加热血清试验(TRUST)滴度下降<4倍或升高的、艾滋病病毒阴性的梅毒患者,检测其血清和脑脊液(CSF)中B淋巴细胞趋化因子-1(BLC-1/CXCL13)的浓度,探讨其与神经梅毒的相关性。方法共68例梅毒患者,实施腰穿检测其脑脊液常规、生化、IgG指数,并进行TRUST、梅毒螺旋体明胶凝集试验(TPPA)、荧光螺旋体抗体吸收试验(FTA-ABS)及性病研究实验室试验(VDRL)检测;采用酶联免疫吸附试验法(ELISA)检测该组患者血清和脑脊液CXCL13的浓度,同时检测正常对照组和治疗阴转组血清CXCL13浓度。结果 68例患者中,有17例(25.0%)为神经梅毒,其脑脊液白细胞计数升高,IgG指数升高,脑脊液CXCL13浓度、脑脊液/血CXCL13比值在有症状神经梅毒组高于无症状神经梅毒组;无症状神经梅毒组同时高于非神经梅毒组;三组之间比较差异有统计学意义(F=17.86,P=0.000)。实验组、对照组和治疗阴转组血清CXCL13浓度比较差异无统计学意义。结论神经系统受累可能是血TRUST滴度不下降的原因之一,神经梅毒患者脑脊液CXCL13浓度、脑脊液/血CXCL13比值异常升高,存在体液免疫反应异常。

Objective The study was to detect the serum and cerebrospinal fluid（CSF）B lymphocyte chemoattractant-1（BLC-1/CXCL13）concentrations in HIV-negative patients with syphilis whose toluidine red untreated serum test（TRUST）titers failed to demonstrate a 4-fold decline or increase 6months after appropriate therapy,and to access the association of its expression with nerosyphilis.Methods CSF and blood were collected from 68HIV-negative patients with syphilis whose TRUST titers fail to demonstrate a 4-fold decline or increase 6months after therapy.CSF TRUST,Treponema pallidum particle agglutination（TPPA）,fluorescent treponemal antibody absorption（FTA-ABS）,Venereal disease research laboratory（VDRL）,IgG index,CSF white blood cells（WBCs）and protein quantification were measured.Serum and CSF CXCL13 concentrations were detected by enzyme linked immunosorbent assay（ELISA）test method.At the same time the serum CXCL13 levels were detected by ELISA in 68 healthy controls and seroreversion patients.Results Totally,17 patients were diagnosed with neurosyphilis（25.0%）.White blood cell count,IgG index were higher in neurosyphilis patients compared with non-neurosyphilis patients.Patients with symptomatic neurosyphilis had higher CSF CXCL13 concentrations and CSF：serum CXCL13 ratio compared to patients with asymptomatic neurosyphilis,such as patients with asymptomatic neurosyphilis compared patients with syphilis but not neurosyphilis.This was statistically significant（F=17.86,P=0.000）.There was no difference in serum CXCL13 concentration between 3groups.Conclusions Failure of nontreponemal test titers to decline fourfold within 6months after therapy for syphilis in HIV-negative patients might be indicative of nervous system infection.CSF CXCL13 concentrations and CSF：serum CXCL13 ratio were significantly high in patients with neurosyphilis.It is abnormal in humoral immunity response.