梅毒螺旋体IgM抗体在梅毒血清固定中的应用

目的：探讨梅毒螺旋体特异性IgM（TP—IgM）抗体在梅毒血清固定中的应用。方法：对285例梅毒患者中病程1年以上,快速血浆反应素环状卡片试验（RPR）阳性且血清固定患者,用免疫印迹法检测TP—IgM抗体。结果：285例梅毒患者中,28例发生血清固定,经TP—IgM检测,阳性8例,阴性20例;28例血清固定患者中,17例二期梅毒患者TP—IgM抗体阳性5例,阴性12例;11例潜伏梅毒患者中TP—IgM抗体阳性3例,阴性8例;无一期梅毒。结论：梅毒螺旋体特异性IgM抗体可作为梅毒血清固定患者感染并活动的一项血清学指标。     

性传播疾病

20140935梅毒螺旋体IgM抗体在梅毒血清固定中的应用/俞莺（无锡市第五医院皮肤科）,袁波∥中国性科学.-2013,22（1）.-33-36 198例RPR阳性患者病程1周-5年,其中28例病程1年以上,且RPR滴度固定;二期梅毒17例,潜伏梅毒11例。应用抗原特异性免疫印迹法检测IP-IgM抗体,阳性8例,阴性20例;其中二期梅毒阳性5例,阴性12例,潜伏梅毒阳性3例,阴性8例。     

神经梅毒患者血清固定一例

患者男,45岁。5年前因其妻患梅毒接受检查,此前1年内有多次非婚性接触史,否认静脉注射毒品史,否认曾出现生殖器硬结和溃疡,否认曾出现不痒的皮肤损害,快速血浆反应素环状卡片试验（RPR）1：64阳性,梅毒螺旋体明胶凝集试验（TPPA）阳性,梅毒螺旋体IgM抗体试验（Tp-IgM,抗体捕获法,试剂由意大利Diasorin公司提供）阳性,抗人类免疫缺陷病毒（HIV）抗体阴性。初步诊断隐性梅毒。以苄星青霉素240万U,每周分侧肌内注射1次,连续治疗3次。     

IgM抗体诊断早期先天梅毒

我们用梅毒特异性19（s)IgM-TPPA抗体检测方法，对5例常规梅毒血清学方法RPR和TPPA两个试验均阳性的新生儿（其母亲已在怀孕时被确诊为不同病期梅毒）进行了检测。患儿中有3例19（s)IgM-TPPA阳性，另2例阴性。最终确诊3例新生儿为先天梅毒。特异性IgM检测应该作为新生儿和早期无症状先天梅毒确诊的实验诊断方法。加强婚前、孕前及早孕期的梅毒筛查和治疗，对控制先天梅毒的发生有重要意义。     

梅毒患者反复发生吉海反应一例

患者男,31岁,因梅毒血清学阳性4年,于2019年3月2日复诊。4年前患者因“生殖器溃疡1周”就诊于苏州大学附属第二医院,阴茎可见一单发、黄豆大小圆形溃疡,边界清楚,创面较清洁,无痛。梅毒螺旋体明胶凝集试验（TPPA）阳性,快速血浆反应素环状卡片试验（RPR）滴度1∶2,HIV抗体阴性,诊断为一期梅毒,予苄星青霉素240万U肌内注射,每周1次,连续3次……     

三种梅毒螺旋体特异性抗体检测方法性能评价

目的：比较电化学发光免疫分析（ECLIA）、化学发光免疫分析（CLIA）、酶联免疫吸附实验（ELISA）三种方法检测梅毒螺旋体特异性抗体的性能差异。方法：通过梅毒螺旋体抗体颗粒凝集试验（TPPA）实验筛选阳性样本和阴性样本各60例,对所有样本的梅毒螺旋体特异性抗体采用三种方法检测,通过受试者工作曲线（ROC）确定不同方法学对梅毒的诊断价值,并确定S/CO最佳截断值,比较不同方法学AUC面积。结果：当ECLIA法S/CO≥5或CLIA法S/CO≥7或ELISA法S/CO≥7时,TPPA法复查检测结果均为阳性。ECLIA法、CLIA法诊断梅毒的灵敏度、特异性、AUC及符合率均大于ELISA法,差异均有统计学意义（均P＜0.05）。结论：当ECLIA、CLIA、ELISA法S/CO分别小于5、7、7时,需采用TPPA进行验证,以减少误诊。ECLIA法、CLIA法诊断价值高于ELISA法。     

化学发光微粒子免疫分析法对梅毒螺旋体特异性抗体的检测价值探究

目的：研究化学发光微粒子免疫分析法（CMIA）对梅毒螺旋体特异性抗体的检测,评价其检测效果,探讨其临床适用性。方法：选择2011年5月～2012年5月在我院就诊的门诊和住院260例患者,分别使用梅毒螺旋体胶凝试验（TPPA）法与CMIA法病人血清,观察两种方法测定的阳性率,并以TPPA法为标准,评价CMIA法的敏感性、特异性、阴性预测值及阳性预测值。结果：CMIA法检出率为16．2％,而TPPA法检出率为14．6％,两种方法的阳性检出率比较,差异无统计学意义（P〉0．05）;CMIA法敏感性100％,特异性98．2％,阳性预测值90．5％,阴性预测值100％,CMIA法与TPPA法检测梅毒螺旋体抗体的符合率为98．7％。结论：CMIA具有自动化、检测周期短等特点,可以为梅毒抗体进行实验室批量检测。其与梅毒螺旋体胶凝试验的检出率相当,特异性也较高,可以结合TPPA及临床资料用于梅毒的确诊,在临床长期推广应用。     

误诊为尿布皮炎的早期先天梅毒一例

患儿,男,4个月。臀部、阴囊、股部红斑1个月。曾于多家医院诊断为尿布皮炎,治疗无效。患儿TPPA阳性,TRUST 1∶512,抗梅毒螺旋体IgM阳性。患儿父母均无皮疹,TPPA均阳性,母亲TRUST滴度1∶32;父亲TRUST滴度1∶64。患儿母亲孕期未进行围产期保健,否认梅毒诊治史,分娩时医院发现母亲血梅毒抗体阳性,未对患儿进行梅毒抗体检测。早期先天性梅毒症状缺乏特异性,容易误诊,医生应予以重视,对疑似梅毒患儿行梅毒抗体检测。     

快速梅毒螺旋体抗体检测试验的实验室初步评价

目的：对不同国家生产的7种快速梅毒螺旋体抗体检测试验效果进行实验室评价，筛选敏感、特异、快速、简便、价廉的快速特异性梅毒螺旋体抗体检测方法。方法：以世界卫生组织推荐的TPPA方法作为“金标准”，采用盲法，分别对92份TPPA阳性血清和阴性血清进行快速试验检测，检测结果由2位观察人员分别判读纪录，并在第一次判读结果后1小时读取第二次结果，以评价7种快速试验的敏感性、特异性、结果判读的一致性以及稳定性等。结果：7种快速试验的敏感性为70．8％～97．9％，其中三种快速试验的敏感性较高，与另外四种试验方法比较有统计学差异；7种方法的特异性为89％～95％，各方法之间均无统计学差异；所有结果判读的一致性及稳定性都很高。结论：实验室对7种快速特异性梅毒螺旋体抗体检测试验效果的实验室评价结果表明：Determine（Abbott，美国）及Bioline（Standard，韩国）有较高的敏感性和特异性，且操作简便、相对价廉，可望作为理想的梅毒螺旋体抗体快速检测试剂推广应用。     

神经梅毒合并银屑病1例

报告1例神经梅毒合并银屑病。患者,男,58岁,因"记忆力下降10年"就诊,1月前在外院复查,发现梅毒非特异性抗体定量实验1∶160阳性。此次入院检查梅毒非特异性抗体(RPR)1∶2阳性,梅毒确证试验(凝集法)阳性。脑脊液常规:红细胞0.006×106/μL,潘台氏蛋白阴性,白细胞12.00×106/L;脑脊液乳酸脱氢酶测定:乳酸脱氢酶24.0 U/L;脑脊液生化:钠149.4 mmol/L,氯126.0 mmol/L,葡萄糖3.9 mmol/L,脑脊液蛋白873.0 mg/L;脑脊液梅毒抗体定量(RPR非特异性抗体):阴性,梅毒确证试验(凝集法)阳性。皮肤科情况:躯干、四肢散在暗红色圆形、椭圆形浸润性斑块,大小不一,部分相融合成片,上覆银白色鳞屑。     

持久性隆起性红斑二例并文献复习

病例1,女,69岁,双足血疱半年。病例2,女,56岁,双膝关节红斑7个月,泛发全身1个月。组织病理均示:表皮下水疱,真皮内可见弥漫的嗜中性粒细胞浸润,血管壁纤维蛋白样变。直接免疫荧光检查:表皮细胞间及基底膜IgG、C3、IgM、IgA阴性。诊断为持久性隆起性红斑。泼尼松治疗有效。     

氨苯砜治疗持久性隆起性红斑一例

患者，男，78岁。躯干、四肢多发紫红色结节、斑块伴疼痛3年。组织病理示:表皮间水肿，真皮浅中层弥漫性中性粒细胞浸润，血管壁界限不清，纤维组织增生。诊断为持久性隆起性红斑。治疗：氨苯砜100 mg每日一次口服，外用卤米松乳膏和夫西地酸乳膏，4个月后皮损明显好转。     

Evaluating the effect of tranexamic acid as mesotherapy on persistent post-acne erythema: A before and after study

Background

Acne vulgaris is a common skin disease that is more common in young population and it can be associated with some sequels after resolving the lesions. Post-inflammatory erythema is one of these complications that can be disturbing for patients and does not have any definite treatment. This study was aimed to evaluate the efficacy and safety of tranexamic acid (TA) as mesotherapy in treatment of post-acne erythema (PAE) treatment.

Method

This clinical trial study was performed in the dermatology clinic on 17 patients with persistent PAE (3 months after acne recovery). Two sessions of treatment were performed by a physician with 2-week intervals; TA was injected as mesotherapy into the right side of each patient's face as the case group, while the opposite side was used as the control group. A Visioface device was used to compare before and after treatment photographs of each side of the face in color mode with quantitative measures such as lesions count, area, and area percent.

Results

Finally, 15 patients completed treatment sessions. There were statistically significant differences in right side lesions before and after treatment with p-values of 0.047, 0.002, and 0.035 for count, area, and area percent, respectively. There was no significant difference before and after treatment in terms of count, area. and area-percent on the left side.

Conclusion

According to the results of this study, TA injection as mesotherapy for resolving PAE can be effective. However, due to small sample size, further studies are needed.     

以面部浮肿性红斑为主要表现的二期梅毒1例

患者男,21岁。全身皮疹5天,经检查TPHA(+),RPR1∶64(+)。诊断为二期梅毒。予苄星青霉素240万U分两侧臀肌注射,1次/周,连续3周治疗后治愈。     

Eosinophilic annular erythema: A late but complete response to hydroxychloroquine

A 69‐year‐old woman with a 12‐month history of asymptomatic erythematous, non‐scaly, annular and arciform plaques on her face, trunk and extremities is presented. The skin lesions had been unresponsive to treatment with systemic corticosteroids and antihistamines. Skin biopsy demonstrated superficial and deep dermal inflammatory infiltration consisting mainly of eosinophils and a few neutrophils. Dermal interstitial mucin deposition was also detected in the absence of vasculitis, flame figures or granulomatous reaction. The patient was diagnosed as having eosinophilic annular erythema and treated with hydroxychloroquine (2 × 200 mg/day, p.o.). Response to treatment was observed after 7 weeks and full recovery was achieved after 10 weeks. Eosinophilic annular erythema is rarely reported in the literature. Although hydroxychloroquine is a good choice for treatment, response time can vary between patients.     

A Case of Herpes-associated Erythema Multiforme in a Japanese Child

A case of a five-year-old Japanese boy with herpes-associated erythema multiforme (HAEM) was reported. The patient had eleven recurrences of herpes labiaris within one year; four of these recurrences were accompanied by erythema multiforme. A study of the human leukocyte antigens revealed the presence of HLA-DQW3, which has been reported to be significantly frequent in Caucasian patients with HAEM. Oral administration of acyclovir at the onset of herpes labialis was effective in preventing HAEM. Early administration of oral steroids at the onset of HAEM also prevented its exacerbation.     

氨苯砜单一疗法治疗持久性隆起性红斑一例并文献复习

报道1例氨苯砜单一疗法治疗持久性隆起性红斑并对既往报道文献进行复习。患者，女，80岁。双手掌、臀部、双下肢及足底红褐色斑片半年。组织病理检查：表皮角化过度、角化不全，棘层轻度增厚，真皮浅中层血管壁纤维蛋白样变性，血管周围轻度嗜中性粒细胞，少许淋巴细胞浸润，局部胶原纤维嗜碱性变。诊断：持久性隆起性红斑。口服氨苯砜100 mg,日1次，3个月后随访，皮损明显好转。     

Reduction of the erythema response to ultraviolet light by nonsteroidal antiinflammatory agents

Summary The effect of three nonsteroidal antiinflammatory agents (NSAIA) on ultraviolet B (UV-B)-induced erythema was studied in normal human volunteers. Aspirin, indomethacin, and ibuprofen were administered orally 2 h before exposure to UV-B from fluorescent sunlamps and at 4-h intervals for a total of four doses. The minimal dose of light to produce erythema (MED) was determined for each subject with and without drugs. There was a 240% increase in the mean MED when the NSAIA were given. NSAIA, given orally, can increase the threshold for UV-B-induced erythema when administered near the time of irradiation.     

Treatment of antiviral‐resistant recurrent erythema multiforme with dapsone

Recurrent erythema multiforme (REM) is a chronic disease characterized by frequent episodes of target cutaneous lesions in an acral distribution. Conventional treatment includes systemic corticosteroids and antiviral therapy. The aim of this study was to evaluate dapsone as a potential steroid sparing‐agent for the treatment of REM after a failed trial of at least one antiviral therapy (acyclovir, famciclovir, or valacyclovir). A retrospective chart review was conducted on thirteen patients with a diagnosis of REM who underwent treatment with dapsone after failing at least one antiviral therapy. Out of 13 patients, 6 showed complete response (CR) and 5 showed partial response (PR). The underlying cause was identified in 5 patients with all showing at least PR. Adverse effects, observed in 4 patients, included fatigue, macrocytic anemia, anxiety, insomnia and involuntary movements, and drug‐induced lupus erythematosus. A continuous course of dapsone, titrated up from 25 mg/day to a dose at which clinical improvement is seen with acceptable patient tolerance, is a viable steroid sparing‐agent for REM treatment after a failed trial of antiviral therapy.     

Clinicopathologic analysis of 66 cases of erythema annulare centrifugum

Erythema annulare centrifugum (EAC) denotes a group of eruptions characterized by slowly migrating annular or configurate erythematous lesions. It can be classified histopathologically as the deep or superficial type. Although there are many case reports of EAC associated with various underlying conditions, no recent clinicopathologic studies exist. The purpose of this study was aimed at analyzing the clinical and histopathologic features of EAC. Sixty-six patients who have been diagnosed as EAC by clinical and histopathological examination were collected. The medical records and skin biopsy specimens of these patients were reviewed retrospectively. There were 24 male patients and 42 female ones. The mean age was 39.7 years, and the mean durtion of the disease was 2.8 years. The lower extremities, particularly the thigh, were the most frequently involved locations. The most common clinical manifestation was large (>1 cm), scaly, erythematous, indurated plaques. Forty-eight patients (72%) had combined diseases including cutaneous fungal infection (48%), such as tinea pedis, other skin diseases (18%), internal malignancies (13%), and other systemic diseases (21%). By histopathologic examination, 33 of 42 patients (78%) were identified as superficial type, and 9 patients (22%) were deep type. Therapeutic trials with systemic or topical corticosteroid and oral antihistamine did not affect the chronic and recurrent course of these patients. EAC is a chronic and recurrent disease despite treatment. EAC is thought to be highly associated with internal disease as well as with superificial fungal infection. However, it was difficult to prove a causal association. The recognition and exact diagnosis of EAC is important, because it may be a quite stressful condition and lead to unnecessary over-treatments.