人类免疫缺陷病毒阴性的无症状型神经梅毒预测因子分析
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摘要
目的研究人类免疫缺陷病毒(HIV)阴性的梅毒人群患无症状型神经梅毒的预测因子。方法回顾性分析2014年5月至2018年1月于首都医科大学附属北京地坛医院神经内科进行腰椎穿刺的HIV阴性且无神经系统受累症状的梅毒患者共162例,其中普通梅毒患者79例,无症状型神经梅毒患者83例。比较两组患者血和脑脊液梅毒螺旋体明胶颗粒凝集试验(TPPA)、甲苯胺红不加热试验(TRUST)、梅毒荧光螺旋体抗体吸附试验IgG(FTA-ABS-IgG)、梅毒荧光螺旋体抗体吸附试验IgM(FTA-ABS-IgM)水平以及脑脊液白细胞和蛋白检测结果。结果无症状型神经梅毒组患者血清TRUST平均滴度为1︰13.09,普通梅毒组患者血清TRUST平均滴度为1︰4.73,差异有统计学意义(Z=-5.344、P<0.001)。患者血清TRUST滴度与患无症状型神经梅毒呈正相关(r=0.421、P<0.001)。血清TRUST滴度≥1︰8与患无症状型神经梅毒呈正相关(r=0.362、P<0.001)。血清FTAABS-Ig M阳性与无症状型神经梅毒呈正相关(r=0.232、P=0.002)。结论 HIV阴性的无症状型神经梅毒患者血清TRUST滴度较普通梅毒患者高。血清TRUST滴度越高,患无症状型神经梅毒的可能越大。血清TRUST滴度≥1︰8、血清FTA-ABS-IgM阳性均提示可能存在无症状型神经梅毒。
Objective To investigate the predictive factors of asymptomatic neurosyphilis in syphilis patients with human immunodeficiency virus(HIV) negative.Methods From May 2014 to January 2018,a total of 162 cases of syphilis with HIV negative and no symptoms of nervous system involvement in Beijing Ditan Hospital,Capital Medical Unversity were analyzed,retrospectively,including 79 cases of noral syphilis and 83 cases of asymptomatic neurosyphilis.The levels of treponema pallidum particle assay(TPPA),toluidine red unheated serum test(TRUST),fluorescent treponemal antibody-absorption IgG(FTAABS-IgG),fluorescent treponemal antibody-absorption IgM(FTA-ABS-IgM) in blood and cerebrospinal fluid(CSF) and the results of leukocyte and protein detection in CSF were compared between the two groups.Results The geometric mean titer of serum TRUST was 1:13.09 in asymptomatic neurosyphilis group and 1:4.73 in noral syphilis group(Z=-5.344,P<0.001).Serum TRUST titer was positively correlated with asymptomatic neurosyphilis(r=0.421,P<0.001).Serum TRUST titer ≥ 1︰8 was positively correlated with asymptomatic neurosyphilis(r=0.362,P<0.001).Serum FTA-ABS-IgM was positively correlated with asymptomatic neurosyphilis(r=0.232,P=0.002).Conclusions The serum TRUST titer of asymptomatic neurosyphilis with HIV negative is higher than that of syphilis.The higher the serum TRUST titer was,the greater the risk of asymptomatic neurosyphilis was.Serum TRUST titer ≥ 1︰8 and positive serum FTAABS-IgM both suggested asymptomatic neurosyphilis.
Objective To investigate the predictive factors of asymptomatic neurosyphilis in syphilis patients with human immunodeficiency virus(HIV) negative.Methods From May 2014 to January 2018,a total of 162 cases of syphilis with HIV negative and no symptoms of nervous system involvement in Beijing Ditan Hospital,Capital Medical Unversity were analyzed,retrospectively,including 79 cases of noral syphilis and 83 cases of asymptomatic neurosyphilis.The levels of treponema pallidum particle assay(TPPA),toluidine red unheated serum test(TRUST),fluorescent treponemal antibody-absorption IgG(FTAABS-IgG),fluorescent treponemal antibody-absorption IgM(FTA-ABS-IgM) in blood and cerebrospinal fluid(CSF) and the results of leukocyte and protein detection in CSF were compared between the two groups.Results The geometric mean titer of serum TRUST was 1:13.09 in asymptomatic neurosyphilis group and 1:4.73 in noral syphilis group(Z=-5.344,P<0.001).Serum TRUST titer was positively correlated with asymptomatic neurosyphilis(r=0.421,P<0.001).Serum TRUST titer ≥ 1︰8 was positively correlated with asymptomatic neurosyphilis(r=0.362,P<0.001).Serum FTA-ABS-IgM was positively correlated with asymptomatic neurosyphilis(r=0.232,P=0.002).Conclusions The serum TRUST titer of asymptomatic neurosyphilis with HIV negative is higher than that of syphilis.The higher the serum TRUST titer was,the greater the risk of asymptomatic neurosyphilis was.Serum TRUST titer ≥ 1︰8 and positive serum FTAABS-IgM both suggested asymptomatic neurosyphilis.
引文
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[14]严有望.抗体几何平均滴度计算中如何处理抗体阴性者[J].微生物学免疫学进展,2000,28(4):98-100.
[15]蔡胜男,伦文辉.梅毒实验室检测及结果解读[J].中国血液净化,2017,16(10):661-663.
[16]王娜,张馨月,张吴琼,等.神经梅毒诊断与治疗新进展[J].中国现代神经疾病杂志,2016,16(7):397-403.
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[19]吴志华,樊翌明.神经梅毒的研究进展与现状[J].中华皮肤科杂志,2004,37(5):313-315.
[20]朱晓华.梅毒的实验室检测技术[J/CD].中华实验和临床感染病杂志(电子版),2013,7(1):132-133.
[21]Zhu L,Gu X,Peng RR,et al.Comparison of the cerebrospinal fluid(CSF)toluidine red unheated serum test and the CSF rapid plasma reagin test with the CSF venereal disease research laboratory test for diagnosis of neurosyphilis among HIV-negative syphilis patients in China[J].J Clin Microbiol,2014,52(3):736-740.
[22]Castro R,Prieto ES,Aguas MJ,et a1.Evaluation of the Treponema pallidum particle agglutination technique(TP.PA)in the diagnosis of neurosyphilis[J].J Clin Lab Anal,2006,20(6):233-238.
[23]陈春晓,蒋荣猛.神经梅毒临床及实验室诊断相关因素的分析[J/CD].中华实验和临床感染病杂志(电子版),2014,8(5):654-657.
[24]Marra CM,Maxwell CL,Smith SL,et al.Cerebrospinal fluid abnormalities in patients with syphilis:Association with clinical and laboratory features[J].J Infect Dis,2004,189(3):369-376.
[25]Xiao Y,Tong ML,Lin LR,et al.Serological response predicts normalization of cerebrospinal fluid abnormalities at six months after treatment in HIV-negative neurosyphilis patients[J].Sci Rep,2017,7(1):9911-9918.
[26]陈小红,杨建,史天威,等.20例HIV抗体阴性神经梅毒患者的临床分析[J].中国艾滋病性病,2007,13(6):560-562.
[2]Marra CM.Neurosyphilis[J].Continuum(Minneap Minn),2015,21(6):1714-1728.
[3]高俊华,李务荣,伍文清,等.46例神经梅毒临床特征及影像学特点[J/CD].中华实验和临床感染病杂志(电子版),2016,10(5):570-574.
[4]Xiao Y,Tong ML,Liu LL,et al.Novel predictors of neurosyphilis among HIV-negative syphilis patients with neurological symptoms:an observational study[J].BMC Infect Dis,2017,17(1):310-321.
[5]魏春波,伦文辉,万钢,等.有症状与无症状神经梅毒患者临床及实验室特征的比较[J/CD].中华实验和临床感染病杂志(电子版),2013,7(3):391-394.
[6]廖非,贾国泉,曹莉,等.HIV阴性神经梅毒18例临床分析[J].国际皮肤性病学杂志,2014,40(3):161-163.
[7]樊尚荣,梁丽芬.2 0 1 5年美国疾病控制中心性传播疾病诊断和治疗指南(续)-梅毒的诊断和治疗指南[J].中国全科医学,2015,18(27):3260-3264.
[8]童曼莉,刘莉莉,林丽蓉,等.梅毒实验诊断程序研究进展[J].中华检验医学杂志,2017,40(11):898-902.
[9]李炳旻,邹先彪.2015年英国梅毒管理指南解读[J].实用皮肤病学杂志,2016,9(4):253-255.
[10]Sun JJ,Wang ZY,Shen JY,et al.Serum TRUST titer≥1:16is a predictor for neurosyphilis among HIV-infected patients with concurrent syphilis and no neurological symptoms[J].Medicine,2015,94(45):e2023.
[11]Pialoux G,Vimont S,Moulignier A,et al.Effect of HIV infection on the course of syphilis[J].AIDS Rev,2008,10(2):85-92.
[12]Workowski KA,Bolan GA.Sexually transmitted diseases treatment guidelines,2015[J].MMWR Recomm Rep,2015,64(3):1-137.
[13]程明浩,邹先彪.2014年欧洲梅毒管理指南解读[J].中国临床医生杂志,2015,43(8),87-90.
[14]严有望.抗体几何平均滴度计算中如何处理抗体阴性者[J].微生物学免疫学进展,2000,28(4):98-100.
[15]蔡胜男,伦文辉.梅毒实验室检测及结果解读[J].中国血液净化,2017,16(10):661-663.
[16]王娜,张馨月,张吴琼,等.神经梅毒诊断与治疗新进展[J].中国现代神经疾病杂志,2016,16(7):397-403.
[17]张耀文,林京京,孙玉冰,等.神经梅毒的研究进展[J].中风与神经疾病杂志,2015,6(6):575-576.
[18]程勇,曹敬荣,王培昌.抗-HIV阴性神经梅毒患者的临床特点与实验室检测分析[J/CD].中华实验和临床感染病杂志(电子版),2016,10(6):669-673.
[19]吴志华,樊翌明.神经梅毒的研究进展与现状[J].中华皮肤科杂志,2004,37(5):313-315.
[20]朱晓华.梅毒的实验室检测技术[J/CD].中华实验和临床感染病杂志(电子版),2013,7(1):132-133.
[21]Zhu L,Gu X,Peng RR,et al.Comparison of the cerebrospinal fluid(CSF)toluidine red unheated serum test and the CSF rapid plasma reagin test with the CSF venereal disease research laboratory test for diagnosis of neurosyphilis among HIV-negative syphilis patients in China[J].J Clin Microbiol,2014,52(3):736-740.
[22]Castro R,Prieto ES,Aguas MJ,et a1.Evaluation of the Treponema pallidum particle agglutination technique(TP.PA)in the diagnosis of neurosyphilis[J].J Clin Lab Anal,2006,20(6):233-238.
[23]陈春晓,蒋荣猛.神经梅毒临床及实验室诊断相关因素的分析[J/CD].中华实验和临床感染病杂志(电子版),2014,8(5):654-657.
[24]Marra CM,Maxwell CL,Smith SL,et al.Cerebrospinal fluid abnormalities in patients with syphilis:Association with clinical and laboratory features[J].J Infect Dis,2004,189(3):369-376.
[25]Xiao Y,Tong ML,Lin LR,et al.Serological response predicts normalization of cerebrospinal fluid abnormalities at six months after treatment in HIV-negative neurosyphilis patients[J].Sci Rep,2017,7(1):9911-9918.
[26]陈小红,杨建,史天威,等.20例HIV抗体阴性神经梅毒患者的临床分析[J].中国艾滋病性病,2007,13(6):560-562.