苄星青霉素对比头孢曲松钠治疗无症状神经梅毒的临床疗效分析

Clinical Efficacy Analysis of Benzathine Penicillin Compared with Ceftriaxone Sodium in the Treatment of Asymp⁃tomatic Neurosyphilis

目的:通过研究芐星青霉素、头孢曲松钠对无症状神经梅毒患者的临床疗效,控制患者脑脊液检测(cerebro⁃spinal fluid test,CFS)及快速血浆反应素环状卡片试验(rapid plasma reagin ring card test,RPR)相关指标来保护患者神经系统。方法:选取2019年7月—2021年3月平顶山市第二人民医院治疗的90例无症状神经梅毒患者作为研究对象。按其治疗方式不同将其分为两组,将采用芐星青霉素治疗的患者列为青霉素组50例,将采用头孢曲松钠治疗的患者列为头孢组40例,所有患者均在治疗前后接受CFS和RPR,对比两组患者治疗前后的脑脊液相关指标[白细胞计数(WBC)、蛋白定量、葡萄糖水平]的变化情况。观察其治疗前、治疗后3个月、6个月、9个月的RPR滴度间的差异,并采用性病研究实验室试验(VDRL)来对其治疗1年后的梅毒复发率进行对比。结果:两组患者治疗后的WBC、蛋白定量、葡萄糖水平等指标对比,差异无统计学意义(t=0.921、0.870、0.630,P>0.05),但头孢组患者治疗后的RPR滴度变化情况明显优于青霉素组;经VDRL试验后结果显示,头孢组患者1年后总的复发率显著低于对照组,差异有统计学意义(χ2=5.862,P<0.05)。结论:临床上对于无症状神经梅毒患者采用芐星青霉素或头孢曲松钠治疗均可,均能够有效改善患者CFS相关指标水平,但相比之下,经头孢曲松钠治疗可更显著改善患者的RPR滴度水平并提高其远期转阴率,同时也可有效降低患者转阴后病情复发的风险,其临床价值更高,建议将头孢曲松钠作为临床上无症状神经梅毒患者首选用药。

Objective:The clinical efficacy of benzathine penicillin and ceftriaxone sodium on asymptomatic neurosyphilis pa⁃tients was studied to protect the nervous system by controlling the cerebrospinal fluid examination(CFS)and rapid plasma reactin ring card test(RPR)related indexes of patients.Methods:90 patients with asymptomatic neurosyphilis treated in the hospital from July 2019 to March 2021 were selected for retrospective analysis and divided into two groups according to treatment modality.Pa⁃tients treated with benzathine penicillin were classified as the penicillin group(n=50)and patients treated with ceftriaxone sodium were classified as the cephalosporin group(n=40).All patients underwent CFS and RPR before and after treatment.The changes of cerebrospinal fluid-related indexes(white blood cell count[WBC],protein quantification,and glucose level)before and after treat⁃ment were compared between the two groups of patients.The differences between their RPR titers before and 3,6,and 9 months af⁃ter treatment were observed,and the syphilis recurrence rate after one year of treatment was compared using the Venereal Disease Research Laboratory test(VDRL).Results:There was no statistically significant difference in WBC,protein quantification and glu⁃cose level between the two groups after treatment(t=0.921,0.870,0.630,P>0.05).The change in RPR titers after treatment was significantly better in the cephalosporin group than in the penicillin group.The results after the VDRL test showed that the overall recurrence rate of patients in the cephalosporin group was significantly lower than that of the control group after one year,and the difference was statistically significant(χ2=5.862,P<0.05).Conclusion:Clinically,patients with asymptomatic neurosyphilis can be treated with either benzathine penicillin or ceftriaxone sodium,both of which can effectively improve the level of CFS-related in⁃dexes.In contrast,treatment with ceftriaxone sodium is of greater clinical value as it improves RPR titers and increases the rate of long-term regression,and also reduces the risk of relapse after regression.Ceftriaxone sodium is recommended as the first choice for asymptomatic neurosyphilis patients in clinical practice.