规范驱梅后无症状神经梅毒患者脑脊液超敏C反应蛋白、降钙素原检测

Detection of High-Sensitivity C-Reactive Protein and Procalcitonin in Cerebrospinal Fluid of Asymptomatic Neurosyphilis Patients After Routine Anti-Syphilis

目的 分析脑脊液超敏C反应蛋白(CSF-hs-CRP)、降钙素原(CSF-PCT)对神经梅毒的诊断价值。方法 选择2019年3月—2023年3月经本科确诊梅毒后经正规苄星青霉素驱梅治疗1年仍然血清阳性的梅毒患者,经脑脊液检查后分为神经梅毒组和非神经梅毒组。结果 神经梅毒组CSF-RPR阳性率为61.54%,CSF-WBC计数[(5.26±2.75)×10^(6)/L]、CSF-Pr水平[(0.42±0.44)g/L]、CSF-hs-CRP水平[(9.73±4.22)mg/L]、CSF-PCT水平[(3.58±1.44)ng/mL]均显著高于非神经梅毒组[(3.21±1.05)×10^(6)/L、(0.37±0.44)g/L、(0.97±0.78)mg/L、(0.61±0.43)ng/mL],差异有统计学意义(P<0.01)。CSF-hs-CRP与CSF-PCT、CSF-WBC、CSF-Pr相关系数分别为0.220、0.018、0.092(P>0.05);CSF-PCT与CSF-WBC、CSF-Pr相关系数分别为0.133、0.039(P>0.05)。CSF-hs-CRP和CSF-PCT灵敏度及特异度分别为0.885、0.828和0.731、0.897。平行诊断敏感度为0.969,系列诊断敏感度为0.647。结论 CSF-hs-CRP、CSF-PCT也是神经梅毒患者CSF存在炎症的证据补充,平行联合诊断在神经梅毒诊断的敏感度方面更具优势。

Objective To analyze the diagnostic value of cerebrospinal fluid high-sensitivity C-reactive protein(CSF-hs-CRP)and procalcitonin(CSF-PCT)in neurosyphilis.Methods From March 2019 to March 2023,syphilis patients who were diagnosed by Department of Dermatology of Chaohu Hospital of Anhui Medical University and were still RPR-positive after one-year regular benzathine penicillin treatment,were divided into neurosyphilis group and non-neurosyphilis group after cerebrospinal fluid examination.Results The positive rate of CSF-RPR in neurosyphilis group was 61.54%.CSF-WBC count[(5.26±2.75)×10^(6)/L],CSF-Pr level[(0.42±0.44)g/L],CSF-hs-CRP levels[(9.73±4.22)mg/L],and CSF-PCT levels[(3.58±1.44)ng/mL]were significantly higher than those in the non-neurosyphilis group[(3.21±1.05)×10^(6)/L,(0.37±0.44)g/L,(0.97±0.78)mg/L,(0.61±0.43)ng/mL],all of which were statistically significant(all P<0.01).The correlation coefficients of CSF-hs-CRP with CSF-PCT,CSF-WBC and CSF-Pr were 0.220,0.018 and 0.092 respectively(all P>0.05).The correlation coefficients of CSF-PCT with CSF-WBC and CSF-Pr were 0.133 and 0.039 respectively(both P>0.05).The sensitivity and specificity of CSF-hs-CRP and CSF-PCT were 0.885 and 0.828,0.731 and 0.897 respectively.The sensitivity of parallel diagnosis was 0.969,and that of serial diagnosis was 0.647.Conclusion CSF-hs-CRP and CSF-PCT are both independent markers of inflammation of CSF in neurosyphilis patients,and they have good sensitivity and specificity when using parallel combined diagnosis on the basis of positive CSF-TPPA.