梅毒携带者并发神经梅毒的危险因素分析

Analysis of Risk Factors of Syphilis Carriers Complicated With Neurosyphilis

目的 探讨梅毒携带者并发神经梅毒的危险因素。方法选择2016年2月—2023年6月仪征市人民医院神经内科收治的64例梅毒携带者,其中并发神经梅毒者33例为研究对象。针对快速血浆反应素试验(rapid plasma reagin test,RPR)持续阳性时间、RPR滴度、脑脊液梅毒螺旋体颗粒凝集试验(treponema pallidum particle agglutination assay,TPPA)结果、脑脊液白蛋白水平、合并人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染、脑脊液白细胞计数、颅内压、是否接受正规梅毒治疗等进行单因素及多因素logistic回归分析。结果 RPR持续阳性时间1年以上,RPR滴度≥1∶8,脑脊液TPPA结果阳性,脑脊液白细胞计数升高为梅毒携带者并发神经梅毒的独立危险因素(P <0.05),接受正规梅毒治疗为预防梅毒携带者并发神经梅毒的保护因素(P<0.05)。结论 对于梅毒RPR试验持续阳性时间超过1年且滴度≥1∶8,脑脊液TPPA结果阳性合并脑脊液白细胞计数升高者,其发生神经梅毒的概率显著增高,故此类患者应更为积极地接受规律治疗。

Objective To explore the risk factors of neurosyphilis in syphilis carriers.Methods A total of 64 cases of syphilis carriers admitted in the People's Hospital of Yizheng from February 2021to September 2023 were selected,among which 33 cases were complicated with neurosyphilis.Single-factor and multi-factor logistic regression analysis was conducted for the duration of positive rapid plasma reagin test(RPR) test,RPR titer,results of treponema pallidum particle agglutination assay(TPPA),albumin level in cerebrospinal fluid,human immunodeficiency virus(HIV),infection in cerebrospinal fluid,white blood cell count in cerebrospinal fluid,intracranial pressure,and whether formal syphilis treatment was accepted or not.Results RPR continued to be positive for more than one year,the titer of RPR was ≥ 1:8,positive results of TPPA in cerebrospinal fluid and increased white blood cell count in cerebrospinal fluid were independent risk factors for syphilis carriers complicated with neurosyphilis(P < 0.05),and receiving regular syphilis treatment was a protective factor to prevent syphilis carriers from complicated with neurosyphilis(P <0.05).Conclusion The probability of neurosyphilis is significantly increased in patients with syphilis RPR test lasting for more than one year and titer ≥ 1:8,positive results of TPPA in cerebrospinal fluid and increased white blood cell count in cerebrospinal fluid,so these patients should receive regular treatment more actively.