杭州地区潜伏梅毒流行病学特征及影响临床疗效的因素分析

Epidemiological Characteristics and Affecting Factor of Clinical Efficacy of Latent Syphilis in Hangzhou Region

目的对杭州地区潜伏梅毒的流行病学特点及对影响临床疗效的因素进行分析,为潜伏梅毒的诊治提供科学依据。方法选择符合诊断标准的杭州地区215例潜伏梅毒患者,记录患者的年龄,性别,学历,职业,就诊原因,病情分期,梅毒甲苯胺红不加热血清试验(TRUST)滴度及梅毒螺旋体抗体检测(TP-Ab)检测结果及使用的治疗药物。治疗后每3个月检测1次TRUST及TP-Ab,直到12个月为止。进行6个月和12个月时的TRUST转阴率和治疗有效率与性别,治疗药物,潜伏梅毒分期及治疗前TRUST滴度的相关性分析。结果杭州地区215例潜伏梅毒中男142例,女73例。职业中农民最多,有65例,其次是工人43例,商业服务36例。文化程度以小学,初中及高中最多,分别有38例,62例及43例。就诊原因中配偶一方有梅毒而就诊的最多,有37例,其次是办理健康证及手术前梅毒抗体筛查阳性,各有35例及31例。早期潜伏、晚期潜伏和不定期潜伏梅毒各有56例,87例及72例。治疗后6个月及12个月时早期潜伏梅毒的TRUST转阴率显著高于晚期及不定期潜伏梅毒,χ2分别为15.65和15.83,均P<0.01,但治疗有效率差异无统计学意义,χ2分别为2.12和1.95,均P>0.05。治疗后6个月及12个月,治疗前TRUST≥1∶16患者的转阴率均显著高于TRUST≤1∶8患者,χ2分别为15.84和49,67,P<0.01,6个月和12个月的有效率上TRUST≥1∶16患者也显著高于TRUST≤1∶8患者,χ2分别为69.16和50.39,均P<0.01。TRUST转阴率及治疗有效率与性别和治疗药物没有明显相关性。结论杭州地区潜伏梅毒以文化程度较低的农民和工人为主,潜伏梅毒的分期及治疗前TRUST滴度高低是影响潜伏梅毒患者TRUST转阴率及治疗有效率的主要因素。

Objective In order to analyze the epidemiological characteristics and influencing factor of clinical efficacy of latent syphilis in Hangzhou region,and to provide a scientific basis for the diagnosis and treatment of latent syphilis.Methods Totally 215 cases of latent syphilis patients in Hangzhou region meeting the diagnostic criteria were recruited,and the patient's age,sex,education,occupation,reasons for seeing a doctor,stage of latent syphilis,treatment drugs,toluidine red untreated serum test(TRUST)titer and Treponema pallidum antibody(TP-Ab)detect results were recorded.TRUST titer was tested every three months for 12 months after treatment.The correlation between TRUST negative turning rate and effective rate of treatment with sex,latent syphilis stage,treatment drugs,TRUST titers before treatment were analyzed.Results Among 215 cases of latent syphilis,there were 142 cases of men and 73 cases of women.Occupations were dominated by farmers with 65 cases,followed by workers with 41 cases and commercial services with 36 cases.Primary school,junior high school and senior high school culture were the most common,with 38 cases,62 cases and 43 cases respectively.The most common reason for seeing a doctor was that one of the spouses had syphilis(37 cases),followed by 35 cases with health certificate and 31 cases with screening TP-Ab positive before operation.Early latent,late latent and unknown latent syphilis were 56,87 and 72 cases,respectively.The negative turning rate of TRUST in patients with early latent syphilis at 6 and 12 months after treatment was significantly higher than those with late latent and unknown latent syphilis(χ2 was 15.65 and 15.83,all P<0.01),but the effective rate of treatment had no significant difference at 6 months and 12 momths after treatment.The TRUST negative turning rate of early latent syphilis was significantly higher than that with late latent and unkwoun latent syphilis at 6 months and 12 months after treatment,χ2 was 15.65 and 15.83,all P<0.01,but the efficiency rate of treatment had no significant difference,χ2 was 2.12 and 1.95,all P>0.05.Patients with TRUST titers≥1∶16 before treatment had significantly higher TRUST negative turning rate than patients with TRUST titers≤1∶8 at 6 and 12 months after treatment,χ2 was 15.84 and 49.67,all P<0.01.And the efficiency rate of treatment of patients with TRUST titers≥1∶16 was also significantly higher than patients with TRUST titers≤1∶8 at 6 and 12 months after treatment(χ2 was 69.16 and 50.39,all P<0.01).There was no relationship between sex and treatment drug and TRUST negative turning rate and effective rate of treatment.Conclusion Peasants and workers with lower education level are the main groups of latent syphilis in Hangzhou region.The stage of latent syphilis and TRUST titesr before treatment are the main factors of affecting TRUST negative turning rate and clinical curative effect.