119例梅毒血清固定患者的临床分析及其外周血中髓系衍生抑制细胞（MDSC）的检测

发布时间：2019-06-16 19:03

【摘要】：【研究目的】通过分析梅毒血清固定患者的临床特点,探讨梅毒血清固定现象的形成原因及其可能相关的影响因素;同时通过对梅毒血清固定患者外周血中MDSC的检测,试图探讨MDSC在梅毒血清固定患者细胞免疫中的作用,为制定梅毒血清固定有效的预防和治疗措施提供依据。【研究方法】 1.对我院皮肤性病科2000年1月至2010年12月收治的有完整临床资料的119例梅毒血清固定患者进行回顾性分析。 2.应用流式细胞术检测梅毒血清固定患者外周血中CD11b+CD33+ HLA-DR- MDSC的比例,同时分析MDSC比例与患者血清固定病程长短及血清固定RPR滴度之间的相关性。【研究结果】 1.发病特征:梅毒血清固定主要发生在性行为活跃的青壮年,男女比例约为1:2.5,自由职业者、工人、个体户占68.07%,高中及初中的文化水平者占64.7%,49.58%的患者合并感染其他性病。 2.梅毒类型及RPR初始滴度:显性梅毒25例(21.01%),潜伏梅毒94例(78.99%)。RPR初始滴度:19例(15.97%)1:64;41例(34.45%)1:32;28例(23.53%)1:16;18例(15.13%)1:8;8例(6.72%)1:4;5例(4.20%)1:2。 3.梅毒血清固定形成时间:显性梅毒血清固定形成时间:17例(68.00%)在半年以内;4例(16.00%)在半年至一年内;4例(16.00%)在一年以上。潜伏梅毒血清固定形成时间:46例(48.94%)在半年以内;26例(约27.66%)在半年至一年内;22例(约23.40%)在一年以上。两者间差异无统计学意义(P0.05)。 4.脑脊液检测:24例患者进行了脑脊液检测,14例TPPA(-)RPR(-);10例TPPA(+)RPR(-)。1例白蛋白量升高,2例乳酸脱氢酶升高,脑脊液颜色、压力、白细胞数均正常。24例患者均未出现神经系统症状和体征。 5.血清固定合并妊娠: 23例梅毒血清固定妊娠妇女经大剂量水剂青霉素规则抗梅治疗后,RPR滴度无增高,未发生梅毒疹,且治疗过程中均未出现明显不良反应。妊娠结局:足月分娩率为95.65%,早产儿发生率仅为4.35%;胎儿出生时体重均在正常范围,发育均未见异常; TPPA(+)RPR(+)者3例(13.04%),TPPA(+)RPR(-)19例(82.61%),TPPA(-)RPR(-)1例(4.35%);无早期先天显性梅毒儿。随访:RPR均于出生后6个月转为阴性,TPPA均于出生后9个月转为阴性;随访2～3年,体格发育与智力发育无异常。 6. T淋巴细胞亚群检测:60例非妊娠及哺乳期患者检测了T淋巴细胞亚群,32例(53.33%)正常, 28例(46.67%)异常,其中26例(43.33%)CD4+ T细胞降低,21例(35.00%)CD8+ T细胞升高,23例(38.33%)CD4+/CD8+比值降低。 7.MDSC检测:梅毒血清固定患者及正常对照组外周血中MDSC比例分别是13.00%±9.22%、6.20%±3.41% ,差异有统计学意义(P0.05)。【研究结论】 1.潜伏梅毒患者较显性梅毒患者可能更易发生血清固定。 2.梅毒血清固定可能与无症状神经梅毒有关。 3.梅毒血清固定合并妊娠妇女使用大剂量水剂青霉素治疗安全、有效,且能控制先天梅毒的发生,改善妊娠结局。 4.CD4+/CD8+比值降低可能与梅毒血清固定的形成有关。 5.外周血中的MDSC明显升高,可能是梅毒血清固定患者细胞免疫功能抑制的原因之一。
[Abstract]:[Study Purpose] Through the analysis of the clinical characteristics of syphilis serum-fixing patients, the causes of the formation of syphilis serum and their possible related factors were discussed, and the role of MDSC in the cellular immunity of the patients with syphilis was studied by means of the detection of MDSC in the peripheral blood of the patients with syphilis, and the effective prevention and treatment measures for the preparation of syphilis serum were provided. According to.[Study [Methods] 1.119 cases of syphilis serum-fixing patients with complete clinical data from January 2000 to December 2010 were carried out in our hospital. 2. The proportion of CD11b + CD33 + HLA-DR-MDSC in the peripheral blood of the patients with syphilis was detected by flow cytometry, and the proportion of MDSC and the duration of the patient's serum fixed course and the serum fixed RPR were analyzed. The correlation between degrees [Study result] 1. The characteristic of the disease: The syphilis serum fixation mainly occurs in the young and middle-aged with active sexual activity, the male and female ratio is about 1: 2.5, the self-employed person, the worker, the self-employed account for 68.07%, the high school and the middle school of the cultural level of 64.7%, 49.58% The type of syphilis and the initial titer of RPR were 25 (21.01%) of dominant syphilis and 94 (78.99%) of latent syphilis. The initial titer of RPR:19 (15.97%)1:64,41 (34.45%)1:32,28 (23.53%)1:16,18 (15.13%)1:8, and 8 (6.72%)1:4. 5 cases (4.20%)1:2. Syphilis serogroup fixed time:17 cases (68.00%) were within six months;4 cases (16.00%) were within six months to one year;4 (16.00%) were over one year; the latent syphilis serum fixed formation time:46 (48.94%) were within half a year;26 (about 27.66%) were within six months to one year; and 22 (about 23.40%) were over one year. 4. Cerebrospinal fluid was detected in 24 patients, RPR (-) RPR (-) in 14 patients, and RPR (-) in 10 patients with TPPA (+).1 case of albumin increased,2 cases of lactate dehydrogenase increased, the color and pressure of the cerebrospinal fluid, and the number of white blood cells were normal. There were no signs and signs of nervous system in 4 patients.5. Serum fixed and combined pregnancy:23 cases of syphilis serum-fixing pregnant women were treated with a large dose of water-based penicillins. The result of pregnancy was 95.65% and the incidence of premature infants was only 4.35%. The birth weight of the fetus was in the normal range and the development was not abnormal; TPPA (+) RPR (+)3 cases (13.04%), TPPA (+) RPR (-)19 cases (82.61%), TPPA (-) RPR (-)1 (-)1 case (4.35%), no early congenital dominant syphilis. Follow-up: RPR was turned negative for 6 months after birth, and the TPPA was turned negative for 9 months after birth; T-lymphocyte subpopulation was detected in 60 non-pregnant and lactating patients,32 (53.33%) were normal,28 (46.67%) were abnormal,26 (43.33%) of CD4 + T cells,21 (35.00%) of CD8 + T cells and 23 cases (38.33%) decrease in the ratio of CD4 +/ CD8 +.7. MDSC detection: the ratio of MDSC in the peripheral blood of the patients with syphilis serum and the normal control group was 13.00%, 9.22%, 6.20, respectively. % 拢3.41 The difference was statistically significant (P0.05).[Study Conclusion] 1. Patients with latent syphilis may be more likely to have more dominant syphilis serum fixation occurs.2. Syphilis serum fixation may be associated with asymptomatic neurosyphilis.3. Syphilis serum fixation combined with pregnant women use a large dose The water aqua penicillins are safe and effective, and can control the occurrence of congenital syphilis and improve the pregnancy knot. 4. The reduction of the ratio of CD4 +/ CD8 + may be related to the formation of syphilis serum.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R759.1

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