100例梅毒血清固定患者临床分析

Clinical analysis of 100 patients with syphilis serofast

目的分析梅毒血清固定患者的流行病学、临床资料和实验室检查结果,探讨发生梅毒血清固定的相关因素。方法依据2015年《梅毒血清固定临床处理专家共识》制定的标准,对2018年1月至2021年12月在深圳市慢性病防治中心皮肤科就诊并确诊梅毒血清固定患者进行结构化问卷调查。调查项目包括:①收集患者的人口学特征、生活行为特征、性病史等临床相关资料;②收集梅毒螺旋体颗粒凝集试验(TPPA)、梅毒甲苯胺红不加热血清试验(TRUST)检测数值,收集脑脊液白细胞计数等实验室相关资料。采用Epidata 3.1进行数据双录入并进行一致性检验。结果100例梅毒血清固定患者中,男37例,女63例,一期梅毒4例(4.0%),二期梅毒19例(19.0%),隐性梅毒77例(77.0%)。88例患者TRUST基线滴度为1∶256~1∶1,TRUST基线滴度≤1∶8者最多,占51.1%,治疗后TRUST滴度维持在1∶8~1∶1者89例,TRUST滴度>1∶8者11例。患者TRUST基线滴度和目前血清固定TRUST滴度相比较,差异有统计学意义(P<0.01)。100例患者首次治疗中97例使用青霉素治疗。57例患者因血清固定进行了第1次复治,其中55例复治仍使用青霉素治疗,2例使用多西环素治疗,治疗后血清滴度仍然未转阴。100例患者中有63例患者进行了脑脊液实验室检查,其中3例为神经梅毒患者治疗后出现梅毒血清固定,60例脑脊液检查无异常。结论女性、隐性梅毒、低基线滴度较容易发生梅毒血清固定。苄星青霉素规范化治疗后仍有较多患者出现血清固定。使用苄星青霉素治疗血清固定疗效不理想,应研发新的治疗药物减少血清固定的发生以及治疗血清固定。

Objective To analyze the epidemiology,clinical data and laboratory results of patients with serofast of syphilis,and explore the related factors of serofast of syphilis.Method According to the standards formulated by the"Expert consensus on the clinical treatment of syphilis serofast"in 2015,a structured questionnaire survey was conducted on the patients who were diagnosed with syphilis serofast in the dermatology department of center for chronic disease prevention of Shenzhen from January 2018 to December 2021.The investigation items included①The demographic characteristics,life behavior characteristics,history of sexually transmitted diseases and other clinical data were collected.②Blood was collected for treponema pallidum particle agglutination test(TPPA),syphilis toluidine red unheated serum test(TRUST),and cerebrospinal fluid was collected for leukocyte count and other test indexes of cerebrospinal fluid.Epidata 3.1 was used for data double entry and consistency test.Result Among the 100 patients with serofast of syphilis,there were 37 males and 63 females.There were 4 patients with primary syphilis(4.0%),19 patients with secondary syphilis(19.0%)and 77 patients with latent syphilis(77.0%).The patients aged from 31 to 40 years old were the most.The baseline titer of toluidine red unheated serum test(TRUST)in 88 patients was 1:256~1:1.The most patients with TRUST baseline titer≤1:8,accounting for 51%.After treatment,89 patients had TRUST titer maintained at 1:8~1:1,and 11 patients had TRUST titer above 1:8.There was significant difference between the baseline TRUST titer and the current titer of serofast sate(P<0.01).Of the 100 patients treated for the first time,97 were treated with penicillin.57 patients were retreated once due to serofast sate,of which 55 cases were still treated with penicillin and 2 cases were treated with doxycycline.The serum titer still did not turn negative after treatment.Among the 100 patients,63 patients had cerebrospinal fluid laboratory examination,of which 3 patients were patients with neurosyphilis.Serofast sate occurred after treatment,and 60 patients had no abnormality in cerebrospinal fluid examination.Conclusion Women,latent syphilis and low baseline titer are more prone to serofast state.Benzathine penicillin can still cause serofast of syphilis in the treatment of syphilis.The curative effect of benzathine penicillin in the treatment of serofast is not ideal.New therapeutic drugs should be developed to reduce the occurrence of serofast and treat serofast of syphilis.