合并HIV感染男男性行为梅毒患者血清学转归

Serological outcome of syphilis in HIV-infected patients among men who have sex with men

目的 探讨合并HIV感染男男性行为梅毒患者的血清学转归及影响因素。方法 回顾性分析571例男男性行为者梅毒合并HIV感染的患者资料,接受苄星青霉素G治疗,随访时间3、6、9、12个月,记录甲苯胺红不加热血清试验(TRUST)滴度,比较不同分期梅毒治疗后12个月TRUST转归情况,并分析与初始CD4^(+)T淋巴细胞计数及是否进行抗逆转录病毒(ART)治疗的相关性。结果 一期梅毒、二期梅毒、早期隐性梅毒、晚期隐性梅毒转阴率分别是81.25%、35.71%、17.65%、12.92%,总有效率分别是93.75%、78.57%、70.59%、60%;血清学转归与CD4^(+)T淋巴细胞计数无关。初诊时已接受及未接受ART患者梅毒血清学转阴率分别是21.45%、24.47%,总有效率分别是67.82%、68.09%,二者均无统计学差异。结论 治疗后12个月一期梅毒转阴率最高,二期梅毒次之,晚期隐性梅毒最低;一、二期梅毒及早期隐性梅毒总有效率无差别,晚期隐性梅毒总有效率较低;CD4^(+)T淋巴细胞计数及是否接受ART不影响治疗效果。

Objective To investigate the serological outcome and influencing factors of syphilis in HIV-infected patients among men who have sex wiht men(MSM).Methods 571 cases were retrospectively analyzed,and received benzathine penicillin G treatment.Toluidine red unheated serum test(TRUST)titers were recorded at 0,3,6,9,12 months after treatment.Serological outcome was assessed at 12 months and the correlation between CD4^(+)T cell count and the use of antiretroviral therapy(ART)was analyzed.Results The TRUST negative conversion rate and the total effective rate of of primary syphilis was 81.25%and 93.75%,that of secondary syphilis was 35.71%and 70.59%,that of early latent syphilis was 17.65%and 70.59%,and that of late latent syphilis was 12.92%and 60%.The TRUST negative conversion rate and the total effective rate of ART group was 21.45%and 67.82%,and that of no ART group was 24.47%and 68.09%(P>0.05).No significant differences were seen between tow groups.Serological outcome of syphilis was not associated with CD4^(+)T cell count.Conclusion There is no difference in the total effective rate among primary、secondary and early latent syphilis in HIV co-infected patients among MSM.The total effective rate of late latent syphilis is lower.Both CD4^(+)T cell count and the use of ART at the first visit do not affect the therapeutic effect.