梅毒血清反应素滴度在神经梅毒腰穿指征中的作用

The Role of Serum Reagin Titer in Lumbar Puncture of Neurosyphilis

目的探讨HIV阴性的梅毒患者血清RPR滴度与神经梅毒的关系。方法回顾性分析2005年6月-2013年10月363例进行腰穿的HIV阴性梅毒患者的数据。应用卡方检验和逻辑回归分析神经梅毒的危险因素,应用ROC曲线分析血清反应素对神经梅毒的诊断价值。结果男性(OR 3.91,95%CI2.49~6.13,P<0.001)及血清RPR滴度与神经梅毒显著相关。血清RPR滴度每增高2倍,发生神经梅毒的几率增高1.39倍(校正OR 1.39,95%CI 1.24~1.55,P<0.001)。血清RPR滴度1∶16诊断神经梅毒时约登指数(0.288)最大,敏感性和特异性分别为43.70%和85.10%。血清RPR滴度诊断神经梅毒的ROC曲线面积为0.680。结论在HIV阴性人群中,尽管血清RPR滴度与神经梅毒显著相关,但以血清RPR滴度诊断神经梅毒容易造成大量患者的漏诊,其不适合作为判断是否需要进行腰穿的指标。

Objective To determine the relation between serum RPR titer and neurosyphilis among HIV-negative syphilis patients. Methods Data of 363 syphilis patients whom perform lumbar puncture from June 2005 to October 2013 was retrospectively reviewed. Chi-square test and Logistic regression model were used to determine the risk factors of neurosyphilis. Receiver operating curve （ ROC ） analysis was performed to determine the performance of serum RPR titer in diagnosis of neurosyphilis. Results Male sex（ OR 3.91,95% CI 2. 49 6. 13 ,P 〈0. 001 ） and serum RPR titer were significantly associated with neurosyphilis. The rank of serum RPR titer was significantly associated with neurosyphilis （ adjusted OR 1.39,95% CI 1.24 - 1.55, P 〈 0. 001 ） for each RPR dilution. Serum RPR titer of 1 ： 16 seemed to be the best cut-off point for performing a lumbar puncture （ Youden＇s index 0. 288, sensitivity 43.70% , specificity 85. 10% ）. The area under the curve（AUC） for serum RPR titer in diagnosis of neurosyphilis was 0. 680. Conclusion Although serum RPR titer was significantly associated with neurosyphilis among HIV-negative patients, diagnosis of neurosyphilis using serum RPR titer would cause missed diagnosis of a large number of patients. Serum RPR titer is not a useful cut-off for performing a lumbar puncture in HIV-negative syphilis patients.