女性潜伏梅毒规范治疗前后血清及阴道分泌物梅毒旋体DNA结果分析

Analysis of the results of Treponema Pallidum DNA in serum and vaginal fluid of patients with latent syphilis before and after treatment

目的探讨早期潜伏梅毒和晚期潜伏梅毒血清及阴道分泌物传染性。 方法2015年1月至2015年12月宁波市妇女儿童医院门诊诊治的潜伏梅毒女性患者68例。其中早期潜伏梅毒38例，晚期潜伏梅毒30例。试剂盒检测甲苯胺红不加热血清试验（tolulized red unheated serum test，TRUST）, PCR检测梅毒螺旋体DNA（Treponema Pallidum DNA，TP-DNA）。比较两组患者治疗前后血清及阴道分泌物中的TP-DNA。统计学处理采用χ2检验。 结果早期潜伏梅毒患者治疗后3、6、12个月时，TRUST转阴分别为11例（28.9%）、16例（42.1%）和27例（71.0%），晚期潜伏梅毒患者TRUST转阴分别为6例（20.0%）、12例（40.0%）和14例（46.7%），早期潜伏梅毒与晚期潜伏梅毒治疗3个月和治疗6个月后TRUST转阴率比较，差异均无统计学意义（χ2值分别为0.716、0.031，均P〉0.05），而治疗后12个月比较，差异有统计学意义（χ2＝4.164，P〈0.05）。早期潜伏梅毒患者治疗前、治疗后3、6、12个月阴道分泌物TP-DNA阳性分别为4例（10.5%）、0例、1例（2.63%）和1例（2.63%），差异无统计学意义（χ2＝6.247，P〉0.05）；血清TP-DNA阳性分别为18例（47.3%）、4例（10.5%）、5例（13.2%）和5例（13.2%），差异有统计学意义（χ2＝21.217，P〈0.05）。晚期潜伏梅毒患者阴道分泌物TP-DNA阳性分别为2例（6.7%）、0例、0例和1例（3.3%），差异无统计学意义（χ2＝3.761，P〉0.05）；血清TP-DNA阳性分别为8例（26.7%）、1例（3.3%）、1例（3.3%）、1例（3.3%），差异有统计学意义（χ2＝14.712，P〈0.05）。 结论规范治疗能明显降低女性潜伏梅毒血清和阴道分泌物的梅毒螺旋体水平并提高TRUST转阴率。晚期潜伏梅毒比早期潜伏梅毒更容易发生血清固定。规范治疗前早期潜伏梅毒的血清传染性更强。

ObjectiveTo investigate the infectivity of serum and vaginal fluid in early cases and late latent cases of syphilis. MethodsFrom January 2015 to December 2015, sixty-eight female patients with latent syphilis were enrolled in the outpatient clinic of Ningbo Women and Children′s Hospital, including 38 early cases and 30 late cases. Tolulized red unheated serum test （TRUST） was detected by using kits and Treponema Pallidum DNA （TP-DNA） was detected by polymerase chain reaction. TP-DNA levels in serum and vaginal fluid were compared before and after benzathine penicillin treatment in patients with early and late latent syphilis. Chi square test was performed for count data analysis. ResultsTRUST negative conversion cases in early latent syphilis after 3, 6 and 12 months of treatment were 11 （28.9%）, 16 （42.1%） and 27 （71.0%）, respectively. TRUST negative conversion cases in late latent syphilis after 3, 6 and 12 months of treatment were 6 （20.0%）, 12 （40.0%） and 14 （46.7%）, respectively. There were no statistical differences in TRUST negative conversion rates after 3 months and 6 months after treatment between early cases and late cases （χ2=0.716 and 0.031, respectively, both P〉0.05）, while those after 12 months of treatment between early cases and late cases were statistical different （χ2=4.164, P 〈0.05）. The vaginal fluid TP-DNA positive cases in early syphilis before and after 3, 6, and 12 months of treatment were 4 （10.5%）, 0, 1 （2.63%） and 1 （2.63%）, respectively, with no statistical difference （χ2=6.247, P〉0.05）. The serum TP-DNA positive cases in early syphilis before and after 3, 6, and 12 months of treatment were 18 （47.3%）, 4 （10.5%）, 5 （13.2%） and 5 （13.2%）, respectively, with statistical difference （χ2=21.217, P〈0.05）. The vaginal fluid TP-DNA positive cases in late syphilis before and after 3, 6, and 12 months of treatment were 2 （6.7%）, 0, 0 and 1 （3.3%）, respectively, with no statistical difference （χ2=3.761, P〉0.05）. The serum TP-DNA positive cases in late syphilis before and after 3, 6, and 12 months of treatment were 8 （26.7%）, 1 （3.3%）, 1 （3.3%） and 1 （3.3%）, respectively, with statistical difference （χ2=14.712, P〈0.05）. ConclusionsStandard treatment can reduce the level of TP in serum and vaginal fluid of latent syphilis women and improve the negative conversion rate of TRUST. Late latent syphilis is easier to create sero-resistance than early cases. The early cases have stronger infectivity than late cases before standard treatment.