结缔组织病患者快速血浆反应素环状卡片试验阳性的临床价值

目的 探讨快速血浆反应素环状卡片试验（RPR）阳性对结缔组织病（CTD）患者的临床诊断和治疗的指导价值。方法 回顾性分析2004年12月-2007年2月在北京协和医院诊断明确、资料完整的15例RPR阳性CTD住院病例，所有患者均进行了梅毒确证试验；从流行病学资料、临床表现、实验室检查和治疗方案上进行分析。结果（1）15例CTD患者，梅毒确证试验阳性7例（阳性率46．7％），RPR假阳性8例（假阳性率53．3％）。（2）RPR假阳性患者中6例为系统性红斑狼疮（SLE），其中3例合并抗磷脂综合征（APS）。（3）7例CTD并发梅毒的患者中，有典型临床表现者4例，有典型流行病学史者2例，5例予以抗梅毒螺旋体治疗。结论 C139患者存在RPR假阳性并不少见，但仍有相当大比例的患者合并梅毒螺旋体感染。对所有RPR阳性患者，应行梅毒确证试验，对疑似梅毒临床表现和有流行病学史的患者．应予抗梅毒治疗。

Clinical Value of Positive Rapid-plasma-reagin Test for Patients with Connective Tissue Diseases

Objective To inve stigate the clinical value of positive rapid-plasma-reagin test （RPR） in the diagnosis and treatment of patients with connective tissue diseases （CTD）. Methods Clinical data of fifteen CTD inpatients with positive RPR were collected from December 2004 to February 2007 in Peking Union Medical College Hospital. All patients underwent treponema pallidum particle agglutination test （TPPA）. Retrospective analysis included epidemiologic data, clinical manifestations, laboratory tests and treatments. Results （1） TPPA tests of 7 cases were positive. True-positive rate of RPR tests was 46.7% and false-positive rate was 53.3%. （2） Among patients with false-positive RPR, 6 cases were diagnosed as systemic lupus erythematosus （SLE） and 3 lupus cases were also complicated with anti-phospholipid sydrome （APS）. （3） Seven cases were diagnosed syphilis. Among them, 4 cases had typical clinical manifestations of syphilis （57.1%） and 2 had epidemiologic history （28.6%）. Five patients were treated with penicillin. Conclusion False-positive RPR is common in CTD patients, but some are actually infected by syphilis. All CTD patients with positive RPR need further specific treponemal tests. Anti-syphilis treatment should be applied to RPR positive patients with probable syphilis clinical manifestations and epidemiologic history.