神经梅毒患者血清及脑脊液免疫学指标诊断特征分析

目的探讨神经梅毒患者血清及脑脊液免疫学诊断特点。 方法选取2013年6月至2016年7月首都医科大学附属宣武医院收治的35例神经梅毒患者，其中32例患者行血清与脑脊液免疫学指标检测，回顾性分析35例患者的检查结果，应用Fisher精确检验比较血清组与脑脊液组IgA、IgM的差异，应用卡方检验比较血清组与脑脊液组IgG的差异，并对脑脊液寡克隆条带阳性检出率和脑脊液24 h IgG合成率进行分析。 结果32例神经梅毒患者检测血清免疫球蛋白，有53.13%(17/32)的患者IgG升高，6.25%(2/32)的患者IgA升高，0%(0/32)的患者IgM升高；脑脊液中，有84.38%(27/32)的患者IgG升高，100.00%(32/32)的患者IgA升高，90.63%(29/32)的患者IgM升高；血清与脑脊液IgA、IgM升高率比较，差异有统计学意义(P<0.01)，IgG升高率比较，差异无统计学意义(χ²＝7.27，P>0.05)。25例神经梅毒患者行CSF寡克隆电泳，IgG寡克隆条带阳性率为100.00%(25/25)，96.00%(24/25)患者脑脊液24 h IgG合成率升高。 结论神经梅毒临床表现多样，是易误诊的可治性疾病。血清及脑脊液IgG多表现为升高，脑脊液IgA、IgM多表现为升高而血清IgA、IgM多表现为正常，脑脊液寡克隆条带阳性，脑脊液24 h IgG合成率升高等免疫学特点对神经梅毒诊断有意义。

Analysis of immunological diagnostic characteristics in serum and cerebrospinal fluid of neurosyphilis patients

ObjectiveTo explore immunological diagnostic characteristics in serum and cerebrospinal fluid (CSF) of neurosyphilis patients. MethodsThirty-five patients with neurosyphilis admitted to Xuanwu Hospital of Capital Medical University during June 2013 to July 2016 were selected for retrospective analysis, including 32 patients with serum and CSF immunological test results. Fisher exact test was used to compare the differences of IgA and IgM between serum group and cerebrospinal fluid group meanwhile, the difference of IgG between serum and cerebrospinal fluid group was compared using Chi-square test. The positive detection rate of oligoclonal bands (OB) and the 24-hour synthesis rate of immunoglobulin in cerebrospinal fluid were also analyzed. ResultsSerum and CSF Immunoglobulin levels were in 32 patients with neurosyphilis. In serum group, IgG level elevated in 53.13%(17/32) patients, IgA level elevated in 6.25% (2/32) patients, and IgM level elevated in 0% (0/32) patient. Nevertheless, CSF-IgG increased in 84.38% (27/32) patients, CSF-IgA increased in 100.00% (32/32) patients and CSF-IgM increased in 90.63% (29/32) patients. There were statistically significant differences in the elevation rate of IgA and IgM between the serum and cerebrospinal fluid group (χ²=56.47, 53.03, P<0.01). There was no statistically significant difference in the elevation rate of IgG between the two groups(χ²=7.27, P>0.05). The positive rate of oligoclonal band in cerebrospinal fluid was as high as 100.00%, the 24-hour synthesis rate of immunoglobulin in cerebrospinal fluid increased in 96.00% (24/25) patients. ConclusionsNeurosyphilis, with various clinical manifastations, is a treatable and easily misdiagnosed disease. Humoral immunity may play an important role in its development. Serum and CSF IgG increase, CSF IgA and IgM elevation and serum IgA and IgM are normal, CSF OB positive, CSF-24 h IgG synthetic ratio elevation are meaningful immunological characteristics for neurosyphilis diagnosis.