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| 不同类型神经梅毒经头孢曲松钠治疗后6个月临床及实验室特征分析 |
| Clinical and laboratory characteristics of different types of neurosyphilis treated with ceftriaxone 6 months after treatment |
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| DOI：10.3969/j.issn.1007-8134.2023.03.06 |
| 中文关键词: 症状 无症状 神经梅毒 快速血浆反应素环状卡片试验 |
| 英文关键词: symptomatic asymptomatic neurosyphilis RPR |
| 基金项目:佑安肝病艾滋病基金－2022年度院内中青年人才孵育项目（YNKTQN2021010） |
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| 中文摘要: |
| 目的?比较症状性神经梅毒与无症状神经梅毒患者接受头孢曲松钠治疗后6个月的疗效及实验室检查指标差异。方法?收集2020年1月—2021年12月就诊于北京佑安医院接受头孢曲松钠治疗的15例症状神经梅毒患者（症状组）与19例无症状神经梅毒患者（无症状组）治疗前及治疗后6个月时的脑脊液（cerebrospinal fluid, CSF）-白细胞（white blood cell, WBC）、CSF-蛋白（CSF-protein）及CSF梅毒螺旋体颗粒凝集试验（treponema pallidum particle assay, TPPA）、快速血浆反应素环状卡片试验（rapid plasma reagent test, RPR）滴度检测结果，以及血RPR滴度检测结果。并对2组的CSF检测结果、血RPR滴度检测结果进行对比分析。结果?症状组的发病年龄、基线血RPR中位数、基线CSF-protein中位数均明显高于无症状组（P均＜0.05）。经过头孢曲松钠驱梅治疗后6个月，症状组中CSF-WBC下降者10例（66.7%），升高者3例（20%），无变化者2例（13.3%）；无症状组CSF-WBC下降患者16例（84.2%），升高者3例（15.8%）。症状组基线CSF-protein定量明显高于无症状组（P＜0.05），症状组中5例患者基线CSF-protein明显升高，治疗后3例（60%）降至正常。2组患者治疗后CSF-WBC及CSF-protein水平均有下降，但下降幅度差异均无统计学意义（P均＞0.05）。2组患者治疗后6个月血RPR下降4倍者分别为5例（33.3%）和7例（36.8%）。结论? 头孢曲松钠可有效治疗不同类型神经梅毒；CSF-WBC是评价治疗效果的有效指标，治疗后6个月血RPR下降≥4倍尚不能对治疗效果进行有效评价，可能需要延长随访时间。 |
| 英文摘要: |
| Objective Comparison of efficacy and laboratory test indicators between symptomatic and asymptomatic neurosyphilis patients after receiving ceftriaxone sodium 6 months later. Methods?The cerebrospinal fluid white blood cells, cerebrospinal fluid protein, cerebrospinal fluid TPPA, cerebrospinal fluid RPR titers and peripheral blood RPR titers of 15 symptomatic neurosyphilis patients (symptomatic neurosyphilis group) and 19 asymptomatic neurosyphilis patients (asymptomatic neurosyphilis group) were collected from Beijing Youan Hospital from January 2020 to December 2021 before treatment and after treatment with ceftriaxone sodium 6 months later. The results of CSF and blood RPR titers were compared between the 2 groups. Results?The age of onset, baseline median blood RPR and baseline median CSF-protein in symptomatic neurosyphilis group were significantly higher than those in asymptomatic neurosyphilis group (P＜0.05). After 6 months of ceftriaxone sodium treatment, 10 cases (66.7%) of CSF-WBC decreased, 3 cases (20%) increased, and 2 cases (13.3%) of no change in symptomatic neurosyphilis group. 16 cases (84.2%) of CSF-WBC decreased and 3 cases (15.8%) of CSF-WBC increased in asymptomatic group. The baseline CSF-protein content in symptomatic group was significantly higher than that in asymptomatic group (P＜0.05), and the baseline CSF-protein content in 5 patients in symptomatic group was significantly higher, and 3 patients (60%) were reduced to normal after treatment. Both CSF-WBC and CSF-protein decreased after treatment, but there was no statistical difference in the decrease amplitude. Blood RPR decreased fourfold 6 months after treatment in 5 patients (33.3%) and 7 patients (36.8%), respectively. Conclusions?Ceftriaxone sodium can effectively treat different types of neurosyphilis. CSF-WBC is an effective indicator to evaluate the therapeutic effect. The decrease of blood RPR≥4 times 6 months after treatment cannot effectively evaluate the therapeutic effect, and it may be necessary to extend the follow-up time to achieve the best evaluation of the therapeutic effect. |
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