深圳市罗湖区178例早期梅毒患者规范化治疗后血清学变化

Serological effect of 178 patients with early syphilis after standardized treatment in Luohu District, Shenzhen

目的了解早期梅毒患者规范化治疗后的血清学效果。方法对经TRUST初筛和TPHA阳性确诊的178例早期梅毒患者(包括一期梅毒12例、二期梅毒38例、早期潜伏梅毒128例)采用苄星青霉素治疗167例,对青霉素过敏者采用多西环素治疗11例,于最后一次治疗后3、6、9、12、18及24个月复诊,分别做TRUST定性和定量试验,比较不同治疗方案、不同梅毒分期及TRUST初始滴度对血清学疗效的影响。结果治疗后24个月TRUST总转阴率为52.25%,苄星青霉素组和多西环素组TRUST转阴率分别为52.69%和45.45%,不同治疗方案TRUST转阴率差异无统计学意义(P>0.05);一期梅毒、二期梅毒及早期潜伏梅毒24个月TRUST总转阴率分别为91.67%、60.53%、46.09%,不同梅毒分期TRUST转阴率差异有统计学意义(P<0.01);治疗前TRUST滴度≤1∶8组和滴度>1∶8组24个月TRUST总转阴率分别为78.05%和30.21%,差异有统计学意义(P<0.01)。结论早期梅毒采用苄星青霉素和多西环素治疗疗效肯定,多西环素可作为青霉素过敏者替代药物;一期梅毒TRUST比早期潜伏梅毒转阴快,治疗前TRUST滴度越高,转阴时间越长,应加强对梅毒患者的追踪随访。

Objective To observe the serological effect of standardized treatment for early syphilis.Methods Totally178 patients with early syphilis,TRUST screening and TPHA positive diagnosis confirmed(including 12 cases of primary syphilis,38 cases of secondary syphilis,128 cases of early latent syphilis),were treated by benzyl penicillin(167 cases),and doxocycline(11 cases)for the people allergic to penicillin.TRUST titers were recorded at 3,6,9,12,18 and 24 months after treatment,then compared the serological effect in different treatment plans,different stages of syphilis and initial TRUST titers.Results The total negative conversion rate of TRUST was 52.25 % in 24 months after treatment,52.69% and 45.45% in the benzyl penicillin group and the doxocycline group,respectively.There was no statistically significant difference in the negative conversion rate of TRUST in different treatment plans(P>0.05);The negative conversion rates of TRUST of primary syphilis,secondary syphilis andlatent syphilis were 91.67%,60.53%,46.09% respectively.There was statistical significant difference among the negative conversion rates of TRUST indifferent stages(P<0.01);The negative conversion rates of TRUST of initial TRUST titer≤1:8 group and>1:8 group were 78.05 % and 30.21 % respectively,and the difference was statistically significant(P<0.01).Conclusion The treatment effect of early syphilis with benzyl penicillin and doxocycline is positive,and doxocycline can be used as an alternative drug for patients who are allergic to penicillin.The negative conversion time of TRUST ofthe primary syphilis is faster than the latent syphilis,and the higher the initial TRUST titer,the longer the negative conversion time.So the follow-up of syphilis patients should be strengthened.