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。     

Immunoglobulins in the cerebrospinal fluid of patients with late syphilis.

The concentrations of immunoglobulins G, A, and M were measured in 62 samples of cerebrospinal fluid from 35 patients with asymptomatic neurosyphilis, 18 with symptomatic neurosyphilis, and nine with late syphilis of other organs. The most frequent and highest increase in IgG and IgA occurred in patients with symptomatic neurosyphilis. IgM was found in only five patients, but its presence, together with an increase in IgG and IgA concentrations, appears to indicate activity of the pathological process and a poor prognosis for the course of the disease.     

脑脊液异常的102例梅毒并发HIV感染患者临床分析

目的:分析梅毒并发HIV感染患者的临床表现、颅脑核磁共振成像、实验室检查、治疗和预后。方法:收集该院2014年8月——2017年11月收治的102例脑脊液检查异常的梅毒患者,将其临床资料进行回顾性分析。结果:102例梅毒患者中男97例,女5例;平均发病年龄(45±3)岁。所有患者HIV初筛及确证试验均为阳性,确诊神经梅毒者51例,排除神经梅毒者51例。所有患者血清快速血浆反应素试验(RPR)及梅毒螺旋体颗粒凝集试验(TPPA)均为阳性。脑脊液检查:35例RPR阳性,98例TPPA阳性,56例梅毒螺旋体(TP)-IgM试验为阳性,29例蛋白定量升高,10例WBC计数≥1.0×10⁹/L。51例确诊神经梅毒患者中,一期及二期梅毒并发HIV发展为神经梅毒患者比例为14.7%,平均时间为9个月。结论:一期或二期梅毒并发HIV患者比早期梅毒未经治疗或未治疗彻底的患者更易引起神经梅毒,脑脊液TP-IgM阳性率较高,早期梅毒并发HIV感染患者建议行脑脊液TP-IgM检查。     

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.     

Examination of the cerebrospinal fluid in syphilis.

In the diagnosis of neurosyphilis, a cerebrospinal fluid cell count or cerebrospinal fluid total protein are inconclusive by themselves, but together with a cerebrospinal fluid VDRL are of great diagnostic value. At present, the VDRL Slide Test on Spinal Fluid remains the serologic test of choice for the diagnosis of neurosyphilis. The significance and specificity of treponemal tests on spinal fluid remain to be established. Like all other laboratory tests, cerebrospinal fluid findings may be variable and an absolute diagnosis of neurosyphilis should not be made on the result of any one laboratory test alone, but should be viewed in light of all laboratory evidence, including serum serologic tests, and clinical findings.     

脑脊液异常的14例梅毒患者临床分析

目的探讨神经梅毒的诊断及脑脊液检查在神经梅毒诊断中的重要性。方法回顾性分析14例梅毒患者临床特点及脑脊液检查结果。结果确诊神经梅毒7例,疑似神经梅毒3例,排除神经梅毒4例。脑脊液检查RPR阳性7例,TPHA阳性13例。脑脊液白细胞计数增高8例,蛋白质测定增高10例。结论神经梅毒诊断无金标准,均需根据临床表现、血清学试验、脑脊液检查及放射学扫描综合判断。部分病例诊断困难。脑脊液检查在神经梅毒诊断中具有不可缺失的重要地位。     

Clinico-laboratory parallels in changes in the cerebrospinal fluid and the immune status of patients with early stages of syphilis

A total of 135 patients with early syphilis were examined, 24 of these with primary seropositive, 31 with secondary new, 70 with secondary relapsing, and 10 with latent early condition. Abnormal shifts were revealed in the cerebrospinal fluid of 51 (37%) patients, in 28 of these Stages I-II shifts, Stages II-III shifts in 10, and Stages III-IV shifts in 13 patients. Clinically the patients with abnormal liquor developed multiple chancres, erosive papules, leukoderma, alopecia, neutrophilia; these patients had suffered from various diseases in the past. Immunologic examinations have detected manifest noncoordination of the immune system: increased counts of the T-lymphocytes and plasmacytes, reduced counts of B-lymphocytes, depressed primary immune response, disordered immunoglobulin ratio.     

梅毒患者外周血单核细胞亚群的研究

目的 探讨未经治疗的一期、二期和隐性梅毒患者外周血单核细胞亚群的变化.方法 流式细胞仪检测58例未经治疗的梅毒患者(包括隐性梅毒36例,一期梅毒8例,二期梅毒14例)的外周血单核细胞CD14highSCD16-亚群和CD14+CD16+亚群.结果 与正常人对照组相比.梅毒患者CD14+CD16+单核细胞所占比例明显升高,所占总单核细胞比例为12.0%±5.0%,而CD14highCD16-Mo亚群明显降低.为88.0%±5.1%,二者差异均有统计学意义.隐性梅毒、一期梅毒、二期梅毒之间CD14highCD16-亚群和CD14+CD16+亚群差异无统计学意义.结论 未经治疗的梅毒患者外周血单核细胞亚群的变化可能与梅毒螺旋体的持续感染有关,与各临床分期相关性不明显.     

Syphilis serology in patients with primary syphilis and non-treponemal sexually transmitted diseases in southern Africa.

The reactivity of a non-specific reagin (RPR) test and a specific treponemal (FTA-ABS) test were determined in 21 patients with primary syphilis, 430 patients with proven non-treponemal genital ulcerations and 719 patients with acute urethritis presenting at a clinic for sexually transmitted diseases in southern Africa. Excluding those 21 cases of primary syphilis, 358 of 1149 tests performed (31%) were found to be reactive by at least one test. The rate of false positive RPR tests was very low (0.02%). Significantly higher rates of seropositivity were detected in patients with genital ulcerations than in patients with acute urethritis. The highest rates were detected among patients with proven lymphogranuloma venereum (34% RPR positive, FTA-ABS positive; 19% RPR negative, FTA-ABS positive). The geometric mean titres (GMT) of positive RPR tests in non-treponemal infections were found to be lower than in darkfield positive cases of genital ulcer disease.