神经梅毒合并HIV阳性患者的脑脊液及血液指标分析

Analysis of cerebrospinal fluid and hematological indicators in patients with neurosyphilis and HIV positive

目的:探讨脑脊液实验室检测在神经梅毒合并HIV阳性患者中的诊断价值及血清快速血浆反应素试验(rapid plasma reagent test,RPR)滴度、CD4+T细胞计数在神经梅毒腰穿指征中的应用。方法:收集2015年1月至2019年12月就诊于北京佑安医院的梅毒合并HIV阳性患者106例,采集脑脊液(cerebrospinal fluid,CSF)进行脑脊液白细胞(CSF-WBC)、脑脊液蛋白(CSF-protein)及脑脊液梅毒螺旋体颗粒凝集试验(treponema pallidum particle assay,TPPA)、RPR滴度检测,采集血液进行RPR滴度、CD4+T细胞计数检测,根据神经梅毒的诊断分神经梅毒组和非神经梅毒组,对两组的脑脊液检测结果、血清RPR滴度及CD4+T细胞计数检测结果进行分析。结果:106例梅毒合并HIV阳性患者中神经梅毒发病率为33.02%,CSF-RPR及CSF-TPPA对HIV阳性梅毒患者发生神经梅毒的诊断敏感性为68.57%和97.14%,特异性为92.96%和49.29%;CSF-WBC和CSF-protein的ROC(受试者工作特征曲线)分析曲线下面积(area under curve,AUC)分别为0.911和0.913,CSF-WBC为10.5/μL、CSF-protein为272.15 mg/L时,约登指数最大;血清RPR≥1∶16患者发生神经梅毒的几率是血清RPR<1∶16患者的1.52倍(OR 1.52,CI 1.14~2.04,P<0.05),CD4+T细胞≤350个/μL发生神经梅毒的几率为CD4+T细胞>350个/μL患者的2.37倍(OR 2.37,95%CI 1.64~3.41,P<0.05)。结论:HIV阳性患者神经梅毒的发病率较高,CSF-RPR对HIV阳性患者发生神经梅毒具有较高的诊断价值,血清RPR滴度≥1∶16和CD4+T≤350个/μL,是HIV阳性患者神经梅毒的危险因素。

Objective:To analyze the diagnostic value of cerebrospinal fluid(CSF)laboratory test in patients with neurosyphilis and HIV positive and the application of RPR(rapid plasma reagin test)titer and CD4+T cell count in neurosyphilis lumbar puncture indication.Methods:One hundred and six patients with syphilis were collected from January 2015 to December 2019 in Beijing You an Hospital.CSF was collected for CSF white blood cell(CSF-WBC),CSF protein(CSF protein)and CSF TPPA(Treponema pallidum particle assistant),According to the diagnosis of neurosyphilis,the patients were divided into neurosyphilis group and non neurosyphilis group.The results of cerebrospinal fluid test,serum RPR titer and CD4+T cell count were analyzed.Results:Totally,the data of 106 cases were collected in the study.The incidence of neurosyphilis in 106 patients with syphilis and HIV positive was 33.02%,and the sensitivities of CSF-RPR and CSF-TPPA to the diagnosis of neurosyphilis in HIV positive syphilis patients were 68.57%and 97.14%,specificities were 92.96%and 49.29%,respectively.ROC(receiver operating characteristic curve)of CSF-WBC and CSF-protein were analyzed(AUC area under).The area under the curve was 0.911 and 0.913,respectively.When CSF-WBC count was 10.5/μL and CSF protein level was 272.15 mg/L,the yoden s index was the highest.The incidence of neurosyphilis in patients with serum RPR≥1∶16 was 1.52 times higher than that in patients with serum RPR<1∶16(OR 1.52,CI 1.14-2.04,P<0.05).The incidence of neurosyphilis in patients with CD4+T cell≤350/μL was 2.37 times higher than that in patients with CD4+T cell>350/μL(OR 2.37,95%CI 1.64-3.41,P<0.05).Conclusion:The incidence of neurosyphilis in syphilis patients with HIV positive is high.CSF-RPR has high diagnostic value for neurosyphilis in syphilis patients with HIV positive.Serum RPR titer more than 1∶16 and CD4+T cells less than 350/μL are risk factors for neurosyphilis in patients with syphilis and HIV positive.