不典型二期梅毒部分免疫学研究
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摘要
目的通过对疑似二期不典型梅毒患者部分免疫学指标的检测，探讨在梅毒的发病过程中机体免疫学的动态变化情况。从免疫学角度加深对该病的认识，为将来通过免疫学手段对该病进行更有效的诊断和治疗奠定理论和实验基础。
方法收取门诊患者，按临床表现进行分组。分为玫瑰糠疹样皮疹伴淋巴结肿大组和不伴淋巴结肿大组，并以健康献血者为正常对照组。采用快速血浆反应素试验(RPR)、梅毒螺旋体血球凝集试验(TPHA)、梅毒螺旋体明胶凝集试验(TPPA)进行梅毒血清学检测；用流式细胞仪和双抗体夹心ELISA法检测不典型二期梅毒患者和典型二期梅毒患者及正常人外周血树突状细胞(DC)各亚型的表达，血清中IL-12和IFN-r的水平。
结果玫瑰糠疹样皮疹伴淋巴结肿大组RPR检出率明显高于不伴淋巴结肿大的玫瑰糠疹样皮疹组和正常人对照组(P=0.001，P＜0.001)，TPHA和TPPA检出率也显著高于其它组(P＜0.001，P＜0.001)。不典型二期梅毒患者外周血髓系树突状细胞亚型(CD11c~+)的表达为(2.51±1.26)％，与正常对照组(0.41±0.19)％比较有显著升高(P＜0.001)，与典型二期梅毒患者组(2.54±1.40)％比较无显著性差异(P＞0.05)。不典型二期梅毒患者外周血淋巴系树突状细胞亚型(CD123~+)的表达为(0.34±0.17)％，与正常对照组(0.34±0.14)％及典型二期梅毒患者组(0.35±0.18)％比较无显著差异(P＞0.05)。不典型二期梅毒患者血清中IL-12、IFN-r的水平分别为(28.08±12.34)pg／mL、(4.10±3.24)pg／mL，分别与正常对照组(0.65±0.17)pg／mL、(0.27±0.21)pg／mL比较显著升高(P＜0.001、P＜0.001)。与典型二期梅毒患者组(28.49±13.13)pg／mL、(4.33±3.44)pg／mL比较无显著性差异(P＞0.05)。
结论玫瑰糠疹样皮疹伴淋巴结肿大时与诊断梅毒的免疫学指标(RPR、TPHA、TPPA)具有相关性；梅毒螺旋体进入体内后主要诱导CD11c~+型DC表达而引发Th1型反应，IL-12及IFN-r参与了梅毒螺旋体进入体内后的免疫过程，可能在梅毒螺旋体的清除过程中发挥重要的免疫调节作用；不典型二期梅毒与外周血免疫学指标(CD11c~+、CD123~+、IL-12、IFN-r)变化有相关性。
Objective To investigate the immunologic changes of parients with the secondary syphilis. Methods Rapid plasma reagin(RPR) test, treponema pallidum haemagglutination assay(TPHA) test and treponema pallidum particle assay(TPPA) test, were used to detect the secondary syphilis, flow cytometry was used to detect DC subsets in peripheral blood and ELISA method was used to detect the serum level of IL-12, IFN-r in patients with the secondary syphilis and the healthy controls. Results The expression of RPR, TPHA and TPPA in the secondary syphilis patients increased more significantly than that in normal controls. The expression of CD11c ~+DC was (2.51±1.26)％in peripheral blood in the secondary syphilis patients, increased more significantly than that in normal controls(0.41±0.19)％. The expression of CD123 ~+DC in peripheral blood in secondary syphilis patients was(0.34±0.17)％, with no significant difference compared with that in controls(0.34±0.14)％. The serum level of IL-12 and IFN-r were (28.08±12.34) pg/mL, (4.10±3.24) pg/mL in the secondary syphilis patients, increased more significantly than that in normal controls(0.65±0.17) pg/mL, (0.27±0.21) pg/mL. Conclusion Be similar to pityriasis rosea with lymphadenectasis had correlation with the changes of RPR test, TPHA test and TPPA test. Treponema pallidum mainly induced the expression of CD11c ~+DC and initiated cell-mediated immune response. IL-12 and IFN-r might take part in the immune processes after treponema pallidum entering into body, and play a prominent role in treponema pallidum clearance. Be similar to pityriasis rosea with lymphadenectasis had correlation with the changes of CD11c ~+DC, CD123 ~+DC, IL-12 and IFN-r.
方法收取门诊患者，按临床表现进行分组。分为玫瑰糠疹样皮疹伴淋巴结肿大组和不伴淋巴结肿大组，并以健康献血者为正常对照组。采用快速血浆反应素试验(RPR)、梅毒螺旋体血球凝集试验(TPHA)、梅毒螺旋体明胶凝集试验(TPPA)进行梅毒血清学检测；用流式细胞仪和双抗体夹心ELISA法检测不典型二期梅毒患者和典型二期梅毒患者及正常人外周血树突状细胞(DC)各亚型的表达，血清中IL-12和IFN-r的水平。
结果玫瑰糠疹样皮疹伴淋巴结肿大组RPR检出率明显高于不伴淋巴结肿大的玫瑰糠疹样皮疹组和正常人对照组(P=0.001，P＜0.001)，TPHA和TPPA检出率也显著高于其它组(P＜0.001，P＜0.001)。不典型二期梅毒患者外周血髓系树突状细胞亚型(CD11c~+)的表达为(2.51±1.26)％，与正常对照组(0.41±0.19)％比较有显著升高(P＜0.001)，与典型二期梅毒患者组(2.54±1.40)％比较无显著性差异(P＞0.05)。不典型二期梅毒患者外周血淋巴系树突状细胞亚型(CD123~+)的表达为(0.34±0.17)％，与正常对照组(0.34±0.14)％及典型二期梅毒患者组(0.35±0.18)％比较无显著差异(P＞0.05)。不典型二期梅毒患者血清中IL-12、IFN-r的水平分别为(28.08±12.34)pg／mL、(4.10±3.24)pg／mL，分别与正常对照组(0.65±0.17)pg／mL、(0.27±0.21)pg／mL比较显著升高(P＜0.001、P＜0.001)。与典型二期梅毒患者组(28.49±13.13)pg／mL、(4.33±3.44)pg／mL比较无显著性差异(P＞0.05)。
结论玫瑰糠疹样皮疹伴淋巴结肿大时与诊断梅毒的免疫学指标(RPR、TPHA、TPPA)具有相关性；梅毒螺旋体进入体内后主要诱导CD11c~+型DC表达而引发Th1型反应，IL-12及IFN-r参与了梅毒螺旋体进入体内后的免疫过程，可能在梅毒螺旋体的清除过程中发挥重要的免疫调节作用；不典型二期梅毒与外周血免疫学指标(CD11c~+、CD123~+、IL-12、IFN-r)变化有相关性。
Objective To investigate the immunologic changes of parients with the secondary syphilis. Methods Rapid plasma reagin(RPR) test, treponema pallidum haemagglutination assay(TPHA) test and treponema pallidum particle assay(TPPA) test, were used to detect the secondary syphilis, flow cytometry was used to detect DC subsets in peripheral blood and ELISA method was used to detect the serum level of IL-12, IFN-r in patients with the secondary syphilis and the healthy controls. Results The expression of RPR, TPHA and TPPA in the secondary syphilis patients increased more significantly than that in normal controls. The expression of CD11c ~+DC was (2.51±1.26)％in peripheral blood in the secondary syphilis patients, increased more significantly than that in normal controls(0.41±0.19)％. The expression of CD123 ~+DC in peripheral blood in secondary syphilis patients was(0.34±0.17)％, with no significant difference compared with that in controls(0.34±0.14)％. The serum level of IL-12 and IFN-r were (28.08±12.34) pg/mL, (4.10±3.24) pg/mL in the secondary syphilis patients, increased more significantly than that in normal controls(0.65±0.17) pg/mL, (0.27±0.21) pg/mL. Conclusion Be similar to pityriasis rosea with lymphadenectasis had correlation with the changes of RPR test, TPHA test and TPPA test. Treponema pallidum mainly induced the expression of CD11c ~+DC and initiated cell-mediated immune response. IL-12 and IFN-r might take part in the immune processes after treponema pallidum entering into body, and play a prominent role in treponema pallidum clearance. Be similar to pityriasis rosea with lymphadenectasis had correlation with the changes of CD11c ~+DC, CD123 ~+DC, IL-12 and IFN-r.
引文
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