不同治疗方案在隐性梅毒感染患者合并皮肤病中的疗效研究

Efficacy of different treatment methods in patients with recessive syphilis infection complicated with skin diseases

目的探讨苄星青霉素联合头孢曲松钠治疗潜伏梅毒患者合并皮肤感染的疗效。方法选取2014年8月-2015年5月医院收治的隐性梅毒感染合并皮疹老年患者86例。随机分为联合组和对照组,每组43例。对照组采用苄星青霉素治疗,联合组采用苄星青霉素联合头孢曲松钠治疗。分别于治疗结束时、治疗后6个月、12个月、18个月和24个月,进行螺旋体血凝(TPPA)和梅毒快速血浆反应素(RPR)血清检查。随访24个月后进行疗效评价。治疗结束时,采集两组患者清晨空腹血检测CD_3^+、CD_4^+、CD_8^+。结果治疗结束时、治疗后6个月、12个月、18个月和24个月,联合组治愈率分别为18.60%、30.23%、51.16%、60.47%和74.42%,显著高于对照组的6.98%、9.30%、23.26%、34.88%和41.86%。治疗24个月后,联合组和对照组总有效率分别为95.35%和79.07%,差异具有统计学意义(P<0.05)。治疗前,两组CD_3^+、CD_4^+、CD_8^+和CD_4^+/CD_8^+均无显著性差异。治疗结束时,联合组CD_3^+、CD_4^+、CD_4^+/CD_8^+分别为(77.95±10.45)%、(45.34±7.10)%和(1.78±0.56),均显著高于对照组的(70.89±4.24)%、(41.22±6.24)%和(1.61±0.18)(P<0.05);联合组CD_8^+(25.44±6.17)%显著低于对照组(27.46±5.76)%(P<0.05)。结论苄星青霉素联合头孢曲松治疗老年隐性梅毒感染并发皮肤病疗效显著,优于单用苄星青霉素治疗,可作为隐性梅毒治疗的首选方案。

OBJECTIVE To investigate the efficacy of benzathine penicillin combined with ceftriaxone sodium in the treatment of patients with recessive syphilis with skin infection.METHODS From Aug.2014 to May 2015,86 patients with recessive syphilis infection and rash in our hospital were enrolled in this study,and were randomly divided into combined group and control group,with 43 cases in each group.Patients in control group were treated with benzathine penicillin,and in combined group were treated with benzathine penicillin and ceftriaxone sodium.At the end of treatment,6 months,12 months,18 months,and 24 months after treatment,spirochetic hemagglutination（TPPA）and syphilis rapid plasma reactin（RPR）serum were performed.The efficacy was evaluated after 24 months follow-up.At the end of treatment,CD_3^＋,CD_4^＋ and CD_8^＋ were measured in early morning fasting blood.RESULTS At the end of treatment,6 months,12 months,18 months,and 24 months after treatment,the cure rates in combined group were 18.60%,30.23%,51.16%,60.47% and 74.42%,respectively,which were significantly higher than 6.98%,9.30%,23.26% 34.88% and 41.86% of control group.After treatment for 24 months,the total effective rates were 95.35% and 79.07% in combined group and control group,respectively,and there was significant difference between the two groups（P〈0.05）.There was no significant difference in CD_3^＋,CD_4^＋,CD_8^＋ and CD_4^＋/CD_8^＋ between the two groups before treatment.At the end of the treatment,the levels of CD_3^＋,CD_4^＋,and CD_4^＋/CD_8^＋ in combined group were（77.95±10.45）%,（45.34±7.10）% and（1.78±0.56）,respectively,which were significantly higher than（70.89±4.24）%,（41.22±6.24）%and（1.61±0.18）in control group（P〈0.05）.The CD_8^＋ level in combined group was（25.44±6.17）%,which was significantly lower than（27.46 ± 5.76）% in control group（P〈0.05）.CONCLUSION The combination of benzathine penicillin and ceftriaxone in the treatment of senile recessive syphilis infection complicated with skin diseases is superior to that of benzathine alone,which can be used as the first choice for treatment of recessive syphilis.