症状性神经梅毒患者强化驱梅治疗前后临床和实验室特征

Clinical and laboratory characteristics of patients with symptomatic neurosyphilis before and after intensive anti-syphilis treatment

目的分析症状性神经梅毒患者强化驱梅治疗前后临床特征和实验室指标变化,及其对疗效评估的意义。方法回顾性分析于首都医科大学附属北京地坛医院住院治疗的29例HIV阴性症状性神经梅毒患者的临床资料。对患者治疗前及治疗结束6个月的血清和脑脊液(CSF)进行甲苯胺红不加热血清试验(TRUST)和梅毒螺旋体明胶颗粒凝集试验(TPPA)。观察血清TRUST(serum-TRUST)和脑脊液中白细胞计数(CSF-WBC)(×106/L)、脑脊液蛋白水平(CSF-PRO)(mg/dl)以及CSFTRUST动态变化,分析以上指标的临床意义及对疗效的评估价值。结果经强化驱梅治疗,于结束治疗6个月时serum-TRUST下降≥4倍的患者8例(27.58%),结束治疗2年后增加至15例(51.72%)。治疗前、结束治疗6个月及2年的患者log2serum-TRUST倒数中位数(四分位数)分别为1.81(1.20,2.11)、1.51(1.20,1.81)和1.20(0.90,1.51),两两比较差异均有统计学意义(P均<0.001)。治疗结束6个月时CSF-TRUST滴度下降≥4倍或阴转的患者共17例(62.97%);治疗前及治疗结束6个月时患者log2CSF-TRUST倒数中位数(四分位数)分别为0.60(0.30,0.90)和0.30(0.00,0.60),差异有统计学意义(Z=-3.012、P=0.003)。治疗前及治疗结束6个月时患者CSF-PRO中位数(四分位数)分别为64.50(52.05,88.55)和50.85(37.28,65.25),差异有统计学意义(Z=-3.238、P=0.001)。结论强化驱梅治疗前后CSF-PRO和CSF-TRUST滴度可用来评估神经梅毒患者的疗效;serum-TRUST滴度下降≥4倍可预测神经梅毒患者的疗效。

Objective To analyze the clinical characterisitcs and laboratory indexes of patients with symptomatic neurosyphilis before and after intensive anti-syphilis therapy, and its significance for curative effect evaluation. Methods Data of 29 patients with HIV-negative symptomatic neurosyphilis in Beijing Ditan Hospital, Capital Medical University were analyzed, retrospectively. Serum and cerebrospinal fluid(CSF) were detected by toluidine red unheated serum test(TRUST) and treponema pallidum particle agglutination test(TPPA) before treatment and 6 months after treatment. The levels of serum TRUST(serumTRUST), white blood cell count in CSF(CSF-WBC)(× 106/L), cerebrospinal fluid protein level in CSF(CSFPRO)(mg/dl) and dynamic changes of CSF-TRUST were detected, respectively. The clinical significance and evaluation value of curative effect of the above indicators were analyzed. Results There were 8 cases(27.58%) with serum-TRUST decreased more than 4 times after 6 months intensive anti-syphilis treatment,which were 15 cases(51.72%) 2 years after treatment. Before treatment, 6 months after treatment and 2 years after treatment, the median(quartile) of log2 serum-TRUST countdown were 1.81(1.20, 2.11), 1.51(1.20, 1.81)and 1.20(0.90, 1.51), respectively, the differences between every two groups were significant(all P < 0.001).There were 17 patients(62.97%) with CSF-TRUST titers decreased more than 4 times or negative at the end of 6 months after treatment. Before treatment and 6 months after treatment, the median(quartile) of log2 serumTRUST countdown were 0.60(0.30, 0.90) and 0.30(0.00, 0.60), respectively, with significant difference(Z =-3.012, P = 0.003). Before treatment and 6 months after treatment, the median(quartile) of CSF-PRO were64.50(52.05, 88.55) and 50.85(37.28, 65.25), respectively, with significant difference(Z =-3.238, P = 0.001).Conclusions Titers of CSF-PRO and CSF-TRUST before and after treatment could be used to evaluate the curative effect of patients with neurosyphilis, and the decrease of serum-TRUST titer ≥ 4 times could predict the curative effect of patients with neurosyphilis.