外周血T淋巴细胞、IL-4及趋化因子CXCL13在神经梅毒患者中的检测意义

The significance of detecting peripheral blood T lymphocytes,IL⁃4 and chemokine CXCL13 in patients with neurosyphilis

目的分析外周血T淋巴细胞、白介素-4(IL-4)及趋化因子CXC配体13(CXCL13)水平检测在神经梅毒患者中的临床意义。方法选取2020年9月至2023年1月四川大学华西医院收治的188例梅毒患者作为研究对象,其中包括62例血清固定患者(血清固定组)及126例神经梅毒患者(神经梅毒组)(包括无症状型31例,早期58例,晚期37例)。另选取同时期于本院门诊和体检就诊的正常健康者(对照组)80名。比较不同人群、梅毒不同病情程度患者外周血T淋巴细胞、IL-4及化因子CXCL13水平。采用受试者工作特征(ROC)曲线分析外周血T淋巴细胞、IL-4及趋化因子CXCL13联合检测对早期神经梅毒识别的诊断价值。结果CD4^(+)、CD4^(+)/CD8^(+)值:神经梅毒组<血清固定组<对照组,差异有统计学意义(P<0.05)。IL-4、CXCL13水平:神经梅毒组>血清固定组>对照组,差异有统计学意义(P<0.05)。CD4^(+)、CD4^(+)/CD8^(+)值:晚期组<早期组<无症状组,差异有统计学意义(P<0.05)。IL-4、CXCL13水平:晚期组>早期组>无症状组,差异有统计学意义(P<0.05)。ROC分析显示,外周血T淋巴细胞、IL-4及趋化因子CXCL13联合检查灵敏度为89.68%,特异度为91.11%,AUC=0.862(95%CI:0.806-0.933),均高于三指标单一检查(P<0.05)。结论外周血T淋巴细胞、IL-4及趋化因子CXCL13水平变化与神经梅毒患者病情密切联系,三者联合检测度对神经梅毒的早期识别诊断具有更好的灵敏度、特异度,在神经梅毒病情进展评估及临床指导上具有更好的应用价值。

Objective To analyze the clinical significance of peripheral blood T lymphocyte,in-terleukin-4(IL-4)and chemokine CXC ligand 13(CXCL13)levels in patients with neurosyphilis.Methods One hundred and eighty-eight patients with syphilis were admitted to West China Hospital of Sichuan Universi-ty from September 2020 to January 2023.The study included 62 patients who were serofixed(serofixed group)and 126 patients with neurosyphilis(neurosyphilis group),which consisted of 31 cases of asymptomatic type,58 cases of early stage and 37 cases of late stage.Additionally,80 normal healthy individuals(control group)who received outpatient and physical examinations at our hospital during the same period were selected.The levels of peripheral blood T lymphocytes,IL-4 and chemical factor CXCL13 were compared among different groups of people and patients with different degrees of syphilis.The Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of the combined detection of peripheral blood T lymphocytes,IL-4 and chemokine CXCL13 in the identification of early neurosyphilis.Results CD4^(+)and CD4^(+)/CD8^(+)val-ues:neurosyphilis group<serofixation group<control group,the difference was statistically significant(P<0.05).IL-4 and CXCL13 levels:neurosyphilis group>serum-fixed group>control group,the difference was statisti-cally significant(P<0.05).CD4^(+)and CD4^(+)/CD8^(+)values:late group<early group<asymptomatic group,the difference was statistically significant(P<0.05).IL-4 and CXCL13 levels:late group>early group>asymptom-atic group,the difference was statistically significant(P<0.05).The ROC analysis showed that the combined detection of peripheral blood T lymphocytes,IL-4 and CXCL13 had a sensitivity and specificity of 89.68%,91.11%,with an AUC of 0.862(95%CI:0.806-0.933).This was higher than the single examination of pe-ripheral blood T lymphocytes,IL-4 and chemokine CXCL13,as well as higher than the three-indicator single test(P<0.05).Conclusion The changes in T lymphocytes,IL-4 and CXCL13 levels in peripheral blood are closely related to the progression of neurosyphilis in patients.The combined detection of these three factors has better sensitivity and specificity for early identification and diagnosis of neurosyphilis.It has greater application value in assessing the prognosis of neurosyphilis and providingclinical guidance.