神经梅毒患者血清胱抑素C水平与临床相关性的研究

Relationship between serum cystatin C level and clinical features in patients with neurosyphilis

目的探讨神经梅毒患者血清胱抑素C(Cys C)水平与临床特征的关系,了解其临床意义。方法选取2016年9月-2018年5月就诊于杭州市西溪医院的神经梅毒患者(30例)、非神经梅毒患者(30例)及健康体检者(20例)。比较分析各组间临床资料的差异;采用免疫比浊法检测各组血清胱抑素C水平,比较各组之间血清抑素C水平差异及治疗前后变化。结果神经梅毒患者血清胱抑素C显著高于非神经梅毒患者及健康对照组(P<0.05),非神经梅毒患者血清Cys C水平有高于健康对照组趋势,但差异无统计学意义(P>0.05)。神经梅毒患者经驱梅治疗后血清胱抑素C可显著下降(P<0.05)。Cys C预测神经梅毒ROC曲线下面积0.71[P=0.022,95%CI(0.53,0.89)],最佳诊断界值为1.09 mg/L,其预测敏感度为55%,特异度为90%;直线相关分析显示,血清胱抑素C水平与脑脊液蛋白水平及简明精神量表评分正相关(r=0.232,P=0.012;r=0.273,P=0.003),血清胱抑素C水平与脑脊液RPR滴度、细胞数及脑脊液压力无明显相关性(r=0.413,P=0.154;r=0.313,P=0.446;r=-0.124,P=0.142)。结论血清胱抑素C与神经梅毒发生具有相关性,可评估神经梅毒病情,并对神经梅毒存在一定的预测价值。

Objective To study the relationship between serum cystatin C(Cys C)level and clinical features in patients with neurosyphilis,and evaluate its clinical significance.Methods We collected 30 patients as neurosyphilis group,30 patients as syphilis(non-neurosyphilis,N-NS)group and 20 healthy as control group between September 2016 and May 2018.The levels of serum Cys C were tested by using immunology turbidimetric method.The clinical and laboratory characteristics were compared among the three groups.Results The patients with neurosyphilis had higher serum Cystatin C levels as compared with the patients with syphilis and healthy control(P<0.05);however,no significant difference between the N-NS and control group(P>0.05).Serum Cystatin C level was significantly decreased in neurosyphilis group after the antisyphilitic treatment(P<0.05).The mean ROC-plot AUC for Cys C was 0.71[P=0.022,95%CI(0.53,0.89)].The optimal threshold value for Cys C was 1.09 mg/L with the sensitivity of 55%and specificity of 90%.The correlation analysis showed that the serum Cys C levels were positively associated with CSF protein levels and MMSE score(r=0.232,P=0.012;r=0.273,P=0.003),but not associated significantly with RPR titer,CSF cell count and CSF pressure(r=0.413,P=0.154;r=0.313,P=0.446;r=-0.124,P=0.142)in patients with neurosyphilis.Conclusion The levels of serum Cys C is significantly associate with neurosyphilis.To test the levels of Cys C can evaluate the severity of the disease and predict the risk of getting neurosyphilis.