梅毒血清固定的临床研究

发布时间：2018-05-31 21:05

  本文选题：梅毒 + 血清固定　； 参考：《复旦大学》2010年硕士论文

【摘要】： 研究背景 梅毒是人类最重要疾病之一,至今仍影响着全球的公共健康。但是随着梅毒的发病率不断上升,越来越多的病人出现治疗后血清学试验不转阴的现象。这种现象被称为血清固定。因此,血清固定也越来越受到大家的关注。但是,梅毒发生血清固定的原因,目前尚未完全明了。但目前广泛认同的是如果患者出现血清固定现象,首先应该排除患者存在再感染或者复发(治疗不规则或者阿奇霉素耐药株引起等),其次应排除潜伏感染如神经梅毒的存在。 目的 通过收集血清固定现象的病人,对其进行脑脊液检查,检查是否存在神经梅毒。并且追溯这些病人的临床、血清学和流行病学资料。统计在这些血清固定现象患者中神经梅毒的发生率,探讨血清固定发生神经梅毒与治疗方式,梅毒分期和血清滴度高低是否存在关系。 材料和方法 收集2008年11月至2010年2月间在我院皮肤科住院梅毒病人。满足以下条件：a.梅毒血清学检查TPPA和RPR皆阳性,HIV阴性。b.早期梅毒治疗后6月或晚期梅毒治疗后12月RPR滴度未转阴。排除其有结缔组织疾病,妊娠和感染等情况后,收住入组。收集入组病人脑脊液,行生化、VDRL、TPPA、RPR和IgG寡克隆带指数分析,并且采集病史。 结果 共入组血清固定病人63人,男性21例,女性42例,女性明显多于男性。其神经梅毒8例,发生率12.70%,男性7例,女性1例,男性明显多于女性。一期梅毒5例,其中发生神经梅毒3例。二期梅毒10例,发生神经梅毒1例。潜伏梅毒48例,其中发生神经梅毒4例。确切概率法检验发现神经梅毒更多发生于一期梅毒中。一期、二期和潜伏梅毒分别占了血清固定患者的6.82%、18.18%和75.00%,说明越是晚期梅毒,其发展为血清固定的可能性越高。青霉素正规治疗23例,头孢曲松钠正规治疗13例,大环内酯类药物正规治疗3例。x2检验得三种治疗方法对神经梅毒的产生没有统计学差异。血清RPR≥1：32者10例,其中4例发生神经梅毒,RPR1：32者共53例,其中4例发生神经梅毒,x2检验后发现血清RPR滴度高低对神经梅毒的发生有意义,RPR≥1：32相较于RPR1：32者更易产生神经梅毒。 结论 血清固定的梅毒患者中,男性21例,女性42例,女性明显多于男性,女性更易被选择性发现潜伏梅毒。血清固定的发生与发现梅毒时的病期有关,越是晚期梅毒,其发生血清固定现象的可能性越大。其中神经梅毒的发生率为12.70%,男性7例,女性1例,男性明显多于女性。相较于二期梅毒和潜伏梅毒,神经梅毒更多出现于一期梅毒。神经梅毒的发生与梅毒的治疗方式没有明显关系。对于血清RPR滴度≥1：32的血清固定患者,其发展为神经梅毒的可能性明显高于血清RPR滴度1：32的患者。
[Abstract]:Research background Syphilis is one of the most important human diseases, and still affects the global public health. However, with the increasing incidence of syphilis, more and more patients have no negative serological test after treatment. This phenomenon is called serum fixation. Therefore, serum fixation has been paid more and more attention. However, the cause of syphilis serum fixation is not fully understood. However, it is widely accepted that if serum fixation occurs in patients, reinfection or recurrence (treatment of irregular or azithromycin resistant strains) should be excluded first, and latent infections such as neurosyphilis should be excluded. Purpose Patients with serum fixation were examined for neurosyphilis by cerebrospinal fluid examination. The clinical, serological and epidemiological data of these patients were also reviewed. The incidence of neurosyphilis in these patients was analyzed. The relationship between the occurrence of neurosyphilis and treatment, the stage of syphilis and the titer of serum was discussed. Materials and methods From November 2008 to February 2010, patients with syphilis in our department of dermatology were collected. Meet the following condition: a. Both TPPA and RPR were positive for syphilis. RPR titer did not turn negative 6 months after early syphilis treatment or 12 months after late syphilis treatment. After excluding connective tissue disease, pregnancy and infection, they are admitted to the group. The cerebrospinal fluid (CSF) was collected from the patients. The RPR and IgG oligoclonal bands were analyzed and the history was collected. Result There were 63 patients (21 males and 42 females) with fixed serum in the group, and the number of females was significantly higher than that of males. There were 8 cases of neurosyphilis, the incidence rate was 12.70%, male 7 cases, female 1 case, male was obviously more than female. There were 5 cases of primary syphilis, including 3 cases of neurosyphilis. There were 10 cases of secondary syphilis and 1 case of neurosyphilis. There were 48 cases of latent syphilis, including 4 cases of neurosyphilis. The exact probabilistic test found that neurosyphilis was more common in primary syphilis. The primary, secondary and latent syphilis accounted for 18.18% and 75.00% of the patients with serum fixation, respectively, indicating that the more advanced syphilis, the more likely it is to develop to serum fixation. There were 23 cases of penicillin regular treatment, 13 cases of ceftriaxone sodium regular treatment and 3 cases of macrolide regular treatment. Conclusion Among the syphilis patients with fixed serum, 21 cases were males and 42 cases were females, and females were more likely to detect latent syphilis selectively than males. The occurrence of serum fixation is related to the stage of syphilis, and the more advanced syphilis, the more likely it is. The incidence of neurosyphilis was 12.70%, male 7 cases, female 1 case, male significantly more than female. Neurosyphilis is more common in primary syphilis than in secondary and latent syphilis. The occurrence of neurosyphilis has no obvious relationship with the treatment of syphilis. For patients with serum RPR titer 鈮，

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