头孢曲松钠对神经梅毒患者外周血中淋巴细胞亚群与血清CXCL13浓度的影响

Effects of ceftriaxone sodium on peripheral blood lymphocyte subsets and serum CXCL13 concentration in patients with neurosyphilis

目的探讨头孢曲松钠对神经梅毒患者外周血中淋巴细胞亚群与血清趋化因子(chemoattractant chemokine ligand,CXCL)13浓度的影响。方法收集2018年1月至2020年1月南京中医药大学附属南京医院收治的82例神经性梅毒患者,随机分为观察组和对照组,每组各41例。观察组给予头孢曲松钠治疗,对照组给予青霉素钠治疗。比较两组患者治疗前后外周血淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))水平、脑脊液及血清CXCL13水平、快速血浆反应(rapid plasma response,RPR)实验、梅毒螺旋体明胶凝聚实验(treponema pallidum gelatin coagulation experiment,TPPA)、红细胞免疫指标水平[免疫黏附促进因子(erythrocyte immune adhesion promoter,FEER)、红细胞C3b受体花环率(erythrocyte C3b receptor rosette rate,RBC-C3bR)、协同肿瘤红细胞花环试验(synergistic tumor erythrocyte rosette assay,ATER)、直向肿瘤红细胞花环试验(straight tumor erythrocyte rosette test,NTER)]及阳性与阴性症状量表(positive and negative symptom scale,PANSS)评分变化情况,比较两组不良反应发生率。结果治疗前,两组患者CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、脑脊液及血清CXCL13、RPR滴度、TPPA阳性率、FEER、RBC-C3bR、ATER、NTER及PANSS总评分比较无统计学意义(P>0.05)。治疗后,相较于对照组,观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、FEER、RBC-C3bR、ATER、NTER水平明显升高,差异有统计学意义[(64.32±5.03)比(59.21±4.95),(34.78±2.05)比(31.23±2.01),(1.85±0.33)比(1.39±0.31),(55.16±5.08)%比(48.57±4.99)%,(19.13±2.01)%比(15.68±1.74)%,(60.44±3.03)%比(55.82±3.16)%,(2.34±0.46)%比(1.56±0.31)%;t值分别为4.65、7.92、6.51、4.87、6.66、5.58、6.97,P值均<0.05];而CD8^(+)、脑脊液及血清CXCL13、RPR滴度、TPPA阳性率及PANSS评分较对照组明显降低,差异有统计学意义[(2.17±1.09)比(23.26±1.14),(136.93±17.85)pg/mL比(159.44±18.73)pg/mL,(62.40±7.72)pg/mL比(69.51±8.04)pg/mL,(16.03±1.71)比(18.96±2.24),26.83%比48.78%,(46.79±3.35)比(60.22±4.38);t/χ^(2)值分别为12.54、4.60、3.33、7.42、4.20、15.60,P值均<0.05]。治疗期间观察组和对照组不良反应发生率分别为7.32%、9.76%,两组比较差异无统计学意义(P>0.05)。结论头孢曲松钠治疗神经性梅毒临床效果显著,并能显著改善患者T淋巴细胞亚群水平及红细胞免疫功能,降低临床症状评分,调节血清及脑脊液CXCL13水平。

Objective To investigate the effect of ceftriaxone sodium on peripheral blood lymphocyte subsets and serum chemoattractant chemokine ligand 13(CXCL13)concentrations in patients with neurosyphilis.Methods A total of 82 patients with neurosyphilis who were treated in Affiliated Nanjing Hospital of Nanjing University of Chinese Medicine from January 2018 to January 2020 were selected.They were randomly divided into an observation group and a control group,with 41 cases in each group.The observation group was given ceftriaxone sodium treatment,and the control group was given penicillin sodium treatment.The levels of peripheral blood lymphocyte subsets(CD3+,CD4+,CD8+,CD4+/CD8+),cerebrospinal fluid and serum CXCL13 levels,rapid plasma response(RPR),Treponema pallidum gelatin coagulation experiment(TPPA),erythrocyte immune indexes levels[erythrocyte immune adhesion promoter(FEER),erythrocyte C3b receptor rosette rate(RBC-C3bR),synergistic tumor erythrocyte rosette assay(ATER),straight tumor erythrocyte rosette test(NTER)],positive and negative symptom scale(PANSS)score changes,and the incidence of adverse reactions were compared between the two groups.Results Before treatment,there were no statistical significances in the total scores of CD3+,CD4+,CD8+,CD4+/CD8+,CXCL13,RPR titer,TPPA positive rate,FEER,RBC-C3BR,ATER,NTER and PANSS between the two groups(P>0.05).After treatment,compared with the control group,the levels of CD3+,CD4+,CD4+/CD8+,FEER,RBC-C3BR,ATER and NTER were significantly higher in the observation group[(64.32±5.03)vs(59.21±4.95),(34.78±2.05)vs(31.23±2.01),(1.85±0.33)vs(1.39±0.31),(55.16±5.08)%vs(48.57±4.99)%,(19.13±2.01)%vs(15.68±1.74)%,(60.44±3.03)%vs(55.82±3.16)%,(2.34±0.46)%vs(1.56±0.31)%]t values were 4.65,7.92,6.51,4.87,6.66,5.58 and 6.97 respectively,All P values<0.05.While the CD8+,CXCL13 in cerebrospinal fluid and serum,RPR titer,postive rate of TPPA and PANSS score in the observation group were significantly lower than the control group[(2.17±1.09)vs(23.26±1.14),(136.93±17.85)pg/mL vs(159.44±18.73)pg/mL,(62.40±7.72)pg/mL vs(69.51±8.04)pg/mL,(16.03±1.71)vs(18.96±2.24),26.83%vs 48.78%,(46.79±3.35)/(60.22±4.38);t/χ^(2) values were 12.54,4.60,3.33,7.42,4.20 and 15.60 respectively,all P values<0.05].The incidence of adverse reactions in the observation group and the control group was 7.32%and 9.76%respectively,and there was no significant difference between the two groups(P>0.05).Conclusion Ceftriaxone sodium has a significant clinical effect in treating neurosyphilis,and can significantly improve the level of T lymphocyte subsets and red blood cell immune function in patients,reduce clinical symptom scores,and regulate the levels of CXCL13 in serum and cerebrospinal fluid.