大剂量水剂青霉素联合匹多莫德片治疗HIV阴性的血清固定梅毒

Large dose aqueous penicillin with pidotimod tablets in HIV-negative patients with serofast syphilis

目的：评估大剂量水剂青霉素联合匹多莫德片治疗HIV阴性的血清固定梅毒的疗效。方法：回顾性分析2010年1月~2013年12月我科159例＂血清固定＂梅毒患者临床资料,根据治疗方案分为3组,A组58例：给予大剂量水剂青霉素联合匹多莫德片治疗;B组40例：给予大剂量水剂青霉素治疗;C组61例：随访期间未接受任何驱梅治疗的血清固定患者;比较3组患者1年后的RPR滴度变化。结果：治疗过程中无1例产生不良反应。98例住院患者中60例治疗前均接受脑脊液检查,确诊无症状神经梅毒5例,疑似神经梅毒15例。随访1年,A组58例中治疗有效19例,其中2例转阴,无效39例;B组40例中治疗有效8例,无效32例;C组5例下降2个滴度,54例血清固定,2例复发。A、B、C组1年后RPR变化差异有统计学意义（χ2=10.633,P〈0.01）,其中A组的高滴度组（RPR≥1∶8）中14例治疗有效,17例血清固定,低滴度组（RPR〈1∶8）中5例治疗有效,22例血清固定,两组1年后RPR变化差异有统计学意义（P〈0.05）。结论：大剂量水剂青霉素联合匹多莫德片联合治疗血清固定患者安全有效,尤其是RPR≥1∶8血清固定患者应积极行脑脊液检查和治疗。

Objective： To evaluate the efficacies of large dose aqueous penicillin plus pidotimod tablets in the treatment of HIV-negative patients with serofast syphilis. Methods： 159 patients with serofast syphilis treated in our department between January 2010 and December 2013 were included,and divided into three groups based on the therapy protocol. Group A（ n = 58） received large dose of aqueous penicillin with pidotimod tablets,group B（ n = 40） were given simple large dose of aqueous penicillin and group C（ n = 61） were blank treatment during the follow-up. Titer of rapid plasma regain（ RPR） was measured for the change in the three groups of patients by the end of follow-up in 12 months. Results： No adverse effects occurred in the treatment process.Sixty of 98 hospitalized patients received examination of the cerebrospinal fluid（ CSF）,in which 5 cases were identified asymptomatic neurosyphilis,and15 were suspected of neurosyphilis. Follow-up in a period of 12 months indicated that 19 in 58 cases were effective（ 2 cases with negative serum） and 39 were ineffective in group A. Eight cases responded well to the treatment and 32 had no response in group B. Declined RPR titer was seen in 2 cases,serofast state in 54 and relapse in 2 in group C. RPR variation was significant in the three groups after one year（ χ2= 10. 633,P〈0. 01）. Patients in group A with high titer（ RPR≥1∶ 8）,14 responded well and 17 were in serofast state; and for those with low titer（ RPR 1∶ 8） 5 were responded well and 22 were in serofast state. The two group were different in RPR change after one year（ P〈0. 05）. Conclusion： Large dose of aqueous penicillin plus pidotimod tablets can be effective and safe for HIV-negative patients with serofast syphilis,however,patients with titer RPR≥1∶ 8 shall be given additional CSF examination and timely medication.