晚期梅毒患者治疗后血清学反应分析

Analysis of serological response after treatment in patients with advanced syphilis

目的：探讨晚期梅毒患者治疗后的血清学反应。方法选择2012年1月—2015年2月在我院治疗的梅毒患者为研究对象，123例为有症状的神经梅毒，9例患者为无症状神经梅毒，21例为隐性梅毒。分析患者治疗后血清及脑脊液 RPR 滴度变化，比较滴度升高患者与未升高患者一般资料的差异。结果所有患者在治疗1个月时复查 RPR 滴度，48例患者滴度升高，占31.4%；15例患者滴度升高4倍及以上，余升高2倍。48例滴度升高的患者，隐性梅毒患者4例，无症状神经梅毒1例升高，有症状神经梅毒43例，有症状神经梅毒治疗1个月后滴度升高比例最高。123例有症状神经梅毒患者复查脑脊液 RPR，7例患者脑脊液 RPR 滴度升高，占5.7%。男性，年龄36岁~45岁的患者，治疗后 RPR 滴度升高的发生率更高（P＆lt;0.05或＆lt;0.01）。结论晚期梅毒患者经正规驱梅治疗后1个月，有部分患者 RPR 滴度反而上升，临床上应予以重视，必要时进行重复驱梅治疗，以提高远期疗效。

Objective To discuss serological response after treatment in patients with advanced syphilis. Methods Syphilis patients treated in our hospital in January 2012-February 2015 were selected as the research subjects,including 123 of symptomatic neurosyphilis,9 cases with asymptomatic neurosyphilis,21 cases with latent syphilis.Serum and cerebrospinal fluid RPR titer changes in patients after treatment were analyzed.General information between patients with high titer and cases with normal titer was compared. Results RPR titer was detected after 1 months of treatment,and 48 cases elevated,accounting for 31.4%;15 cases with the titer increased 4 times and above, and others increased 2 times.In 48 cases with elevated titers,4 cases were of latent syphilis,1 case was of asymptomatic neurosyphilis increased,and 43 patients were of asymptomatic neurosyphilis. Titer increasing percentage of cases with asymptomatic neurosyphilis was highest after 1 month of treatment. Cerebrospinal fluid RPR was detected in 123 cases of symptomatic neurosyphilis patients,and 7 cases increased,accounting for 5.7%. The incidence of elevated RPR titers in male,aged 36-45 years old patients were higher after treatment （P〈0.05or〈0.01）.Conclusion Late syphilis after 1 month of formal treatment,some patients RPR titer increases. In clinical work,repeated antisyphilitic treatment is necessary to improve curative effect.