神经梅毒患者外周血T淋巴细胞亚群水平检测及临床意义

Detection of T-lymphocyte subsets in peripheral blood of patients with neurosyphilis and its clinical significance

目的探讨外周血T淋巴细胞亚群CD3^(+)、CD4^(+)、CD8^(+)水平和CD4^(+)/CD8^(+)比值识别早期神经梅毒的作用。方法回顾性分析2020年2月至2022年1月杭州市西溪医院神经内科因梅毒就诊的100例患者的临床资料,根据有无神经系统累及分为神经梅毒组和非神经梅毒组,每组50例。选取同期我院的50名健康体检者作为对照组。比较患者和对照组受试者CD3^(+)、CD4^(+)、CD8^(+)T淋巴细胞水平和CD4^(+)/CD8^(+)比值。采用受试者工作特征(ROC)曲线分析外周血T淋巴细胞亚群识别早期神经梅毒的价值。结果神经梅毒组、非神经梅毒组和对照组的CD4^(+)T淋巴细胞水平分别为(30.48±4.08)%、(32.16±4.08)%、(34.50±4.49)%,CD4^(+)/CD8^(+)比值分别为(1.25±0.19)、(1.35±0.25)、(1.47±0.23),3组比较差异有统计学意义(F=11.428、11.970;P<0.01);两两比较,差异均有统计学意义(均P<0.05)。将神经梅毒组患者分为早期组(n=30)、晚期组(n=20)并与对照组进行比较,结果显示CD4^(+)T淋巴细胞水平分别为(31.23±4.28)%、(29.35±3.57)%、(34.50±4.49)%,CD4^(+)/CD8^(+)比值分别为(1.29±0.21)、(1.18±0.13)、(1.47±0.23),3组比较差异有统计学意义(F=12.289、15.350;P<0.01)。晚期组的CD4^(+)T淋巴细胞水平、CD4^(+)/CD8^(+)比值低于对照组,CD4^(+)/CD8^(+)比值低于早期组,差异有统计学意义(P<0.05)。CD4^(+)/CD8^(+)比值预测神经梅毒的ROC曲线下面积为0.725(95%CI:0.645~0.805),高于CD3^(+)、CD4^(+)和CD8^(+)。结论CD4^(+)T淋巴细胞水平或CD4^(+)/CD8^(+)比值下降高度提示神经梅毒,CD4^(+)/CD8^(+)比值更有助于早期识别神经梅毒。

Objective To explore the role of T-lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+))in early recognition of neurosyphilis.Methods A total of 100 patients with syphilis in Department of Neurology,Xixi Hospital of Hangzhou from February 2020 to January 2022 were retrospectively analyzed.There were 50 cases in neurosyphilis group and 50 cases in non-neurosyphilis group.50 health examinees from our hospital in the same period were selected as the control group.The levels of CD3^(+),CD4^(+),CD8^(+)of T-lymphocyte and the ratio of CD4^(+)/CD8^(+)were compared among the three groups.The value of T-lymphocyte subsets in peripheral blood in identifying early neurosyphilis was analyzed by using the receiver operating characteristic(ROC)curve.Results The levels of CD4^(+)T-lymphocytes in the neurosyphilis group,the non neurosyphilis group and the control group were(30.48±4.08)%,(32.16±4.08)%and(34.50±4.49)%,respectively,and the CD4^(+)/CD8^(+)ratios were(1.25±0.19),(1.35±0.25)and(1.47±0.23),respectively.The differences among the three groups were statistically significant(F=11.428,11.970;P<0.01).The differences between every two groups were statistically significant(P<0.05).The patients in neurosyphilis group were divided into early group(n=30)and late group(n=20)and compared with the control group.The results showed that the levels of CD4^(+)T-lymphocytes were(31.23±4.28)%,(29.35±3.57)%,(34.50±4.49)%,and the CD4^(+)/CD8^(+)ratios were(1.29±0.21),(1.18±0.13),(1.47±0.23),respectively.There was a statistically significant difference among the three groups(F=12.289,15.350;P<0.01).The CD4^(+)T-lymphocyte level and CD4^(+)/CD8^(+)ratio in the late stage group were lower than those in the control group,and the CD4^(+)/CD8^(+)ratio was lower than those in the early stage group,with statistically significant differences(P<0.05).The area under the ROC curve(AUC)predicted by CD4^(+)/CD8^(+)ratio was 0.725(95%CI:0.645-0.805),higher than that of CD3^(+),CD4^(+)and CD8^(+).Conclusions The significant decrease of CD4^(+)level or CD4^(+)/CD8^(+)ratio is highly suggestive of neurosyphilis,CD4^(+)/CD8^(+)is more helpful for early identification of neurosyphilis.