RPR持续阳性梅毒患者脑脊液梅毒检测的意义

目的　观察RPR持续阳性梅毒患者无症状神经梅毒的发生情况 ,并探讨其临床意义。方法　对 69例经过数疗程常规驱梅治疗但RPR持续阳性 ( 1年以上 )且无神经系统临床表现的梅毒患者的脑脊液进行梅毒抗体检测。结果　有 16例梅毒患者脑脊液存在梅毒抗体。结论　部分RPR持续阳性梅毒患者存在无症状神经梅毒 ,可能是RPR持续阳性的原因之一。     

RPR持续阳性梅毒患者的传染性与细胞免疫的相关性研究

目的:检测RPR持续阳性经治梅毒患者外周血淋巴细胞亚群,探讨其传染性与细胞免疫的相关性。方法:应用流式细胞仪检测RPR持续阳性梅毒患者中38例IgM阳性和32例IgM阴性的患者外周血T细胞亚群及NK细胞,并以30例健康人作为对照组。结果:IgM阳性组外周血CD3、CD4和CD8细胞均高于对照组(P<0.05),而NK细胞低于对照组(P<0.001);IgM阴性组外周血CD3、CD4细胞低于对照组(P<0.05),而CD8细胞及NK细胞均高于对照组(P<0.05);两组之间外周血淋巴细胞亚群的检测结果相比,IgM阳性组CD3、CD4细胞高于IgM阴性组(P<0.001),NK细胞低于IgM阴性组(P<0.001),而CD8细胞相比差异无显著性(P>0.05)。结论:RPR持续阳性梅毒患者存在明显的细胞免疫不平衡和免疫抑制;NK细胞显著降低可能是RPR持续阳性且具传染性的主要原因。     

未治梅毒患者脑脊液梅毒抗体及外周血淋巴细胞亚群检测

近年来,梅毒的发病率呈逐年上升趋势^[1],为了解无症状神经梅毒的发生情况,及其与梅毒患者细胞免疫之间的关系,我们应用快速血浆反应素环状卡片试验(RPR)、性病研究实验室试验(VDRL)、梅毒螺旋体血球凝集试验(TPHA)、荧光梅毒螺旋体抗体吸收试验(FTA-ABS)等方法对36例未治且无神经损害表现和5例未治神经梅毒的梅毒患者的脑脊液进行梅毒抗体检测;同时应用流式细胞仪检测这些患者的外周血T细胞亚群及天然杀伤(NK)淋巴细胞。     

梅毒患者脑脊液检测的意义

目的：观察梅毒患者无症状神经梅毒发生情况，并探讨其意义。方法：对126例HIV阴性梅毒患者的脑脊液进行常规、梅毒暗视野检查、聚合酶链反应(PCR)及梅毒抗体检测。结果：在126例患者脑脊液中，常规检测发现82例(65．08％)蛋白升高，41例(32．54％)葡萄糖升高，未发现红细胞和白细胞；TP—PCR及梅毒暗视野检查均阴性；有42例(33．33％)梅毒患者脑脊液至少存在一种至一种以上梅毒抗体。结论：梅毒患者脑脊液存在异常，未经治疗梅毒患者脑脊液梅毒抗体检出率，高于经数疗程驱梅治疗但RPR持续阳性一年以上梅毒患者脑脊液梅毒抗体检出率。表明部分患者存在无症状神经梅毒，并可能与RPR持续阳性有关。     

梅毒IgM抗体持续阳性和未治梅毒患者外周血淋巴细胞亚群的比较

一般认为,早期梅毒患者经常规驱梅治疗后,外周血快速血浆反应素环状卡片试验(RPR)在2年内基本转为阴性,梅毒IgM抗体阴转得更早,但临床上部分患者即使经过数疗程常规驱梅治疗,RPR仍然阳性。为了解这类梅毒患者细胞免疫系统状况,我们应用流式细胞仪检测经过2年以上常规驱梅治疗、但梅毒IgM抗体持续阳性和未治梅毒患者外周血淋巴细胞亚群,并比较两组患者细胞免疫的差异。     

未治和血清固定梅毒患者外周血淋巴细胞亚群的比较研究

目的检测未治和血清固定梅毒患者外周血T淋巴细胞亚群及NK淋巴细胞,比较两组患者之间细胞免疫的差异.方法应用流式细胞仪检测40例未治梅毒患者和32例血清固定梅毒患者外周血T淋巴细胞亚群及NK淋巴细胞,并与30例健康人群的检测结果相对照.结果未治梅毒患者CD3、CD4及NK淋巴细胞与对照组的检测结果相比差异无显著性(P＞0.05),而CD8淋巴细胞高于对照组(P＜0.001);血清固定梅毒患者组外周血CD3、CD4及CD8淋巴细胞均低于对照组的检测结果(P＜0.05),而NK淋巴细胞高于对照组(P＜0.001);两组患者外周血CD3、CD4、CD8及NK淋巴细胞相比,差异有显著性(P＜0.05).结论未治和血清固定梅毒患者存在细胞免疫不平衡和免疫抑制.     

梅毒螺旋体IgM抗体对于神经梅毒的诊断意义

目的　探讨检测脑脊液中梅毒螺旋体IgM抗体对于神经梅毒的诊断意义。 方法　神经梅毒组 2 1例 ,以无神经系统被累的各期梅毒组 2 8例、非梅毒组 2 8例为对照。对三组患者腰穿取脑脊液 ,采用抗体捕获酶联免疫吸附分析技术 ,进行梅毒螺旋体IgM抗体检测。 结果　神经梅毒组脑脊液Tp IgM检测的阳性率为 71.4% ,两对照组则均为 0 ,差异有高度显著性 (u =5 .3 7,P <0 .0 1)。脑脊液Tp IgM试验、VDRL/RPR试验在神经梅毒组的阳性率分别为 71.4%、3 3 .3 % ,差异有显著性 (χ2 =4.90 ,P <0 .0 5 )。结论　脑脊液Tp IgM检测有助于神经梅毒的诊断 ,无症状神经梅毒的脑脊液Tp IgM检测也可以呈阳性结果。     

早期梅毒患者外周血T淋巴细胞亚群检测结果分析

目的：检测早期梅毒患者外周血T淋巴细胞亚群,了解机体在梅毒感染早期的细胞免疫改变。方法：选取早期梅毒患者21例,对照组12例。应用流式细胞仪检测外周血CD3＋、CD4＋、CD8＋淋巴细胞亚群,并对结果进行统计学分析。结果：梅毒组患者CD3＋、CD4＋、CD8＋T细胞比例均高于对照组,但只有CD4＋T细胞比例差异有统计学意义（P=0.016）,CD3＋、CD8＋T细胞比例及CD4＋/CD8＋差异均无统计学意义（P=0.340）。结论：早期梅毒患者细胞免疫增强,有利于消除梅毒螺旋体感染。     

梅毒患者外周血树突状细胞亚型的表达

目的通过检测梅毒患者外周血树突状细胞(DC)各亚型的表达,分析其与快速血浆反应素实验(RPR)滴度的相关关系,了解树突状细胞在梅毒的发病机制中的作用.方法应用流式细胞仪测定23例梅毒患者和17例正常人的外周血DC各亚型的表达;RPR检测梅毒患者血清抗心磷脂抗体.结果23例梅毒患者外周血髓系树突状细胞亚型(CD11c )的表达为(1.51±2.04)%,与17例正常对照组(0.37±0.17)%比较显著升高(P＜0.01),梅毒患者外周血淋巴系树突状细胞亚型(CD123 )的表达为(0.37±0.21)%,与正常对照组(0.39±0.21)%比较无显著差异(P＞0.05).梅毒患者泛发皮疹组与非泛发皮疹组比较,CD11c 的表达分别为(1.28%±1.93)%和(1.94±2.31)%,CD123 的表达分别为(0.33±0.21)%和(0.44±0.21)%,两组间无显著差异(P＞0.05).CD11c 及CD123 的表达与RPR滴度不存在相关关系(r分别为-0.15和0.32,P均＞0.05).结论梅毒螺旋体进入体内后主要诱导CD11c 型DC表达,引发Th1反应,启动细胞免疫;DC各亚型的表达与梅毒患者皮疹面积以及病情的活动程度无相关关系.     

神经梅毒合并HIV阳性患者的脑脊液及血液指标分析

目的：探讨脑脊液实验室检测在神经梅毒合并HIV阳性患者中的诊断价值及血清快速血浆反应素试验（rapid plasma reagent test, RPR）滴度、CD4+T细胞计数在神经梅毒腰穿指征中的应用。方法：收集2015年1月至2019年12月就诊于北京佑安医院的梅毒合并HIV阳性患者106例,采集脑脊液(cerebrospinal fluid, CSF)进行脑脊液白细胞（CSF-WBC）、脑脊液蛋白（CSF-protein）及脑脊液梅毒螺旋体颗粒凝集试验(treponema pallidum particle assay, TPPA)、RPR滴度检测,采集血液进行RPR滴度、CD4+T细胞计数检测,根据神经梅毒的诊断分神经梅毒组和非神经梅毒组,对两组的脑脊液检测结果、血清RPR滴度及CD4+T细胞计数检测结果进行分析。结果：106例梅毒合并HIV阳性患者中神经梅毒发病率为33.02%,CSF-RPR及CSF-TPPA对HIV阳性梅毒患者发生神经梅毒的诊断敏感性为68.57％和97.14％,特异性为92.96％和49.29％;CSF-WBC和CSF-protein的ROC（受试者工作特征曲线）分析曲线下面积（area under curve, AUC）分别为0.911和0.913,CSF-WBC为10.5/μL、CSF-protein为272.15 mg/L时,约登指数最大;血清RPR≥1∶16患者发生神经梅毒的几率是血清RPR<1∶16患者的1.52倍（OR 1.52,CI 1.14～2.04,P<0.05）,CD4+T细胞≤350个/μL发生神经梅毒的几率为CD4+ T细胞>350个/μL患者的2.37倍（OR 2.37, 95％ CI 1.64～3.41,P<0.05）。结论：HIV阳性患者神经梅毒的发病率较高,CSF-RPR对HIV阳性患者发生神经梅毒具有较高的诊断价值,血清RPR滴度≥1∶16和CD4+T≤350个/μL,是HIV阳性患者神经梅毒的危险因素。     

Effect of early and late syphilis on central nervous system: cerebrospinal fluid changes and neurological deficit.

Neurological examination and investigation of the cerebrospinal fluid (CSF) was performed on 24 patients with early and 180 patients with late syphilis. In 21 (12%) patients with late syphilis positive CSF treponemal test results and neurological deficits suggestive of symptomatic neurosyphilis were found. Concomitantly all but three patients with neurosyphilis showed one or more of the following abnormal CSF variables: CSF concentration of albumin X 10(3)/serum concentration (albumin ratio) greater than or equal to 7.9; mononuclear cells greater than 5 microliters: ratio of CSF to serum IgG concentrations/ratio of CSF to serum albumin concentrations (IgG index) greater than or equal to 0.7 or of IgM/albumin (IgM index) greater than or equal to 0.1; or oligoclonal CSF immunoglobulins. In 20 (95%) patients with neurosyphilis evidence of the production of treponemal antibodies within the central nervous system (CNS) was shown. Ten (48%) patients with neurosyphilis had been treated previously for late syphilis. These observations emphasise the need to screen for neurosyphilis in patients with late syphilis. Intrathecal production of treponemal antibodies was detected in six (25%) patients with early and 44 (28%) with late syphilis who did not show any neurological deficit. Intrathecal production of treponemal antibodies indicating that the CNS was affected led us to suspect asymptomatic neurosyphilis in these patients. Seventeen (11%) patients with late syphilis but no neurosyphilis and only one (4%) with early syphilis showed additional abnormal CSF variables. Surprisingly, six out of 22 patients with treated early and 20 out of 68 patients with treated late syphilis showed evidence of treponema antibody production within the CNS. We do not know whether these findings indicate that the CNS was affected because of inadequate treatment or merely reflect persistent synthesis of treponemal antibodies associated with cured infection. In one (4%) patient with early and in 21 (13%) with late syphilis but no neurosyphilis abnormal CSF variables in the absence of positive CSF treponemal test results were observed, which excluded syphilitic inflammation of the CNS.     

Treponema pallidium IgM enzyme-linked immunosorbent assay (TP-IgM-ELISA). Determination of organism-specific Treponema IgM antibodies in the serum of syphilis patients with and without central nervous system involvement of the infection

For demonstration of treponemal IgM antibodies in sera and CSF taken from 56 syphilitic patients with or without involvement of the CNS in the infection, comparative studies have been performed making use of the 19S(IgM)-FTA-ABS test and a TP-IgM-ELISA. Compared with the 19S(IgM)-FTA-ABS, the TP-IgM-ELISA has a specificity of 97% and a sensitivity of 93%. With regard to qualitative investigation of serum samples, both tests showed nearly equivalent results. In 10 out of 16 CSF samples taken from patients with untreated neurosyphilis, a treponemal IgM antibody could be proved by TP-IgM-ELISA. According to these findings, this assay seems to be a reliable test system for demonstration of treponemal IgM antibodies not only in serum but also in CSF.     

Evaluation of cerebrospinal fluid in asymptomatic late syphilis

To help determine the role of lumbar puncture in evaluation of patients with asymptomatic late syphilis, we reviewed results of cerebrospinal fluid (CSF) testing of 47 asymptomatic patients with syphilis. Syphilis was of unknown duration (n = 27) or known duration of greater than one year (n = 20), and all patients had reactive rapid plasma reagin (RPR) tests and reactive fluorescent treponemal antibody absorption tests. Thirty-two per cent of subjects had abnormal CSF findings; these included elevated protein in nine (19%) of 47 and pleocytosis in six (13%) of 47. In most cases, the etiology of these abnormalities was uncertain. Asymptomatic neurosyphilis, diagnosed on the basis of a reactive Venereal Disease Research Laboratory (VDRL; Atlanta, GA) test of CSF, was present in three (6%) of 47 patients. Of the eight patients with RPR titers of greater than or equal to 1:128, three (38%) had neurosyphilis. These results suggest that lumbar puncture is indicated for patients with asymptomatic late syphilis or syphilis of unknown duration.     

梅毒血清固定与神经梅毒患者淋巴细胞亚群的检测

目的探讨梅毒治疗有效、血清固定、神经梅毒与外周血淋巴细胞(PBLC)亚群的关系。方法应用流式细胞仪检测20例梅毒治疗有效患者、23例梅毒血清固定患者、16例神经梅毒患者及20例健康人群的外周血淋巴细胞亚群。结果各组梅毒患者外周血CD4细胞(分别为29.79±5.47,31.79±6.72,33.84±8.81)、CD4/CD8比值(分别为1.34±0.46,1.54±0.70,1.62±0.67)均显著低于对照组(分别为43.50±8.93,2.20±0.43)(P<0.01);治疗有效组患者B细胞(CD19,12.26±3.43)显著高于对照组(9.00±2.04)(P<0.01),NK细胞(16.81±6.95)显著低于对照组(26.35±9.93,P<0.05);血清固定组患者NK细胞(15.82±8.44)显著低于对照组(P<0.01)。结论T淋巴细胞亚群的改变和NK细胞减少与梅毒血清固定和发展成神经梅毒推断有一定关系。     

Lymphocyte subsets in peripheral blood of patients with moderate-to-severe versus mild plaque psoriasis

In several studies peripheral blood T-cells have been quantified, yet few data are available on lymphocyte subsets in moderate-to-severe psoriasis (in terms of extent and activity of lesions) versus mild psoriasis. The objective is to compare lymphocyte subsets in peripheral blood of patients with moderate-to-severe disease (PASI-score ≥12) to patients with mild disease (PASI-score <12) and to healthy subjects. By means of flow cytometry method, lymphocytes in peripheral blood of 27 patients with psoriasis and 10 healthy controls were characterized. The absolute number of total lymphocytes was markedly decreased in patients with moderate-to-severe psoriasis as compared to patients with mild disease and normal subjects. Cellcounts of all analysed subsets were found to be increased in more severe psoriasis, except for CD8+CD45RO+ cells. The under-representation of CD8+CD45RO+ cells is compatible with the dynamics of acquired immunity, which requires a time log after the relapse of the lesions to differentiate from CD45RA+ naive cells.     

HIV阴性神经梅毒患者血清和脑脊液实验室检查回顾性分析

目的分析神经梅毒患者血清和脑脊液实验室检查结果在不同病程分组之间是否具有差异性。方法以30名正常人为阴性对照,对28名HIV阴性神经梅毒患者的住院病案进行回顾性分析,用SPSS13.0软件包进行统计学分析。结果早期神经梅毒患者16例(57.1%),晚期神经梅毒患者12例(42.9%),没有无症状神经梅毒患者入院接受治疗。神经梅毒患者脑脊液白细胞计数、葡萄糖含量以及蛋白含量比对照组明显升高,早期与晚期患者之间血清和脑脊液RPR滴度、TPAb检测、白细胞计数、葡萄糖含量及蛋白含量实验室检查结果差异无统计学意义。结论早期神经梅毒在入院病人中所占比重较大;神经梅毒患者血清和脑脊液RPR滴度与TPAb检测敏感性高,脑脊液细胞计数和生化检查结果可以为诊断提供参考;不能将神经梅毒患者血清和脑脊液实验室检查结果作为判定神经梅毒病程进展情况及分期的依据。     

Women with recurrent vaginal candidosis have normal peripheral blood B and T lymphocyte subset levels.

OBJECTIVE: To compare the B and T lymphocyte subset levels of otherwise healthy women suffering from frequently recurrent vaginal candidosis with a healthy control group. SUBJECTS: 26 unselected otherwise healthy women of reproductive age with at least four attacks of vaginal candidosis in the past year and more than three vaginal isolates of a moderate or heavy growth of Candida albicans. Controls were 26 patients or clinical and laboratory staff (asymptomatic for genital infection) matched for time of day and age within 5 years. Only three patients accepted an HIV test. All proved HIV negative. No controls were tested. MAIN OUTCOME MEASURES: T lymphocyte subsets (CD4 and 8) and B lymphocytes (CD 19) as estimated from the total lymphocyte count and flow cytometry. RESULTS: No statistically significant difference between patients and controls. CONCLUSION: No significant difference was found between patients and controls in levels of lymphocyte subsets.     

Neurosyphilis.

In patients with abnormal neuropsychiatric symptoms and a reactive fluorescent treponemal antibody absoption (FTA-ABS) test in the cerebrospinal fluid (CSF) or serum, a normal CSF cell count and total protein concentration does not exlude late syphilis involving the central nervous system. In these patients, the presence of plasma cells in the CSF cytogram, increased concentration of CSF immunoglobulin G (IgG), immunoelectrophoretic abnormalities in the precipitates of the IgG and of the Fab fragments of IgG in the CSF immunoelectropherogram, and an increased serum level of immunoglobulin M (IgM) suggest an active, potentially treatable neurosyphilis.