本文選題：梅毒 + 血清固定��； 參考：《復(fù)旦大學(xué)》2010年碩士論文

【摘要】： 研究背景 梅毒是人類最重要疾病之一,至今仍影響著全球的公共健康。但是隨著梅毒的發(fā)病率不斷上升,越來(lái)越多的病人出現(xiàn)治療后血清學(xué)試驗(yàn)不轉(zhuǎn)陰的現(xiàn)象。這種現(xiàn)象被稱為血清固定。因此,血清固定也越來(lái)越受到大家的關(guān)注。但是,梅毒發(fā)生血清固定的原因,目前尚未完全明了。但目前廣泛認(rèn)同的是如果患者出現(xiàn)血清固定現(xiàn)象,首先應(yīng)該排除患者存在再感染或者復(fù)發(fā)(治療不規(guī)則或者阿奇霉素耐藥株引起等),其次應(yīng)排除潛伏感染如神經(jīng)梅毒的存在。 目的 通過(guò)收集血清固定現(xiàn)象的病人,對(duì)其進(jìn)行腦脊液檢查,檢查是否存在神經(jīng)梅毒。并且追溯這些病人的臨床、血清學(xué)和流行病學(xué)資料。統(tǒng)計(jì)在這些血清固定現(xiàn)象患者中神經(jīng)梅毒的發(fā)生率,探討血清固定發(fā)生神經(jīng)梅毒與治療方式,梅毒分期和血清滴度高低是否存在關(guān)系。 材料和方法 收集2008年11月至2010年2月間在我院皮膚科住院梅毒病人。滿足以下條件：a.梅毒血清學(xué)檢查T(mén)PPA和RPR皆陽(yáng)性,HIV陰性。b.早期梅毒治療后6月或晚期梅毒治療后12月RPR滴度未轉(zhuǎn)陰。排除其有結(jié)締組織疾病,妊娠和感染等情況后,收住入組。收集入組病人腦脊液,行生化、VDRL、TPPA、RPR和IgG寡克隆帶指數(shù)分析,并且采集病史。 結(jié)果 共入組血清固定病人63人,男性21例,女性42例,女性明顯多于男性。其神經(jīng)梅毒8例,發(fā)生率12.70%,男性7例,女性1例,男性明顯多于女性。一期梅毒5例,其中發(fā)生神經(jīng)梅毒3例。二期梅毒10例,發(fā)生神經(jīng)梅毒1例。潛伏梅毒48例,其中發(fā)生神經(jīng)梅毒4例。確切概率法檢驗(yàn)發(fā)現(xiàn)神經(jīng)梅毒更多發(fā)生于一期梅毒中。一期、二期和潛伏梅毒分別占了血清固定患者的6.82%、18.18%和75.00%,說(shuō)明越是晚期梅毒,其發(fā)展為血清固定的可能性越高。青霉素正規(guī)治療23例,頭孢曲松鈉正規(guī)治療13例,大環(huán)內(nèi)酯類藥物正規(guī)治療3例。x2檢驗(yàn)得三種治療方法對(duì)神經(jīng)梅毒的產(chǎn)生沒(méi)有統(tǒng)計(jì)學(xué)差異。血清RPR≥1：32者10例,其中4例發(fā)生神經(jīng)梅毒,RPR1：32者共53例,其中4例發(fā)生神經(jīng)梅毒,x2檢驗(yàn)后發(fā)現(xiàn)血清RPR滴度高低對(duì)神經(jīng)梅毒的發(fā)生有意義,RPR≥1：32相較于RPR1：32者更易產(chǎn)生神經(jīng)梅毒。 結(jié)論 血清固定的梅毒患者中,男性21例,女性42例,女性明顯多于男性,女性更易被選擇性發(fā)現(xiàn)潛伏梅毒。血清固定的發(fā)生與發(fā)現(xiàn)梅毒時(shí)的病期有關(guān),越是晚期梅毒,其發(fā)生血清固定現(xiàn)象的可能性越大。其中神經(jīng)梅毒的發(fā)生率為12.70%,男性7例,女性1例,男性明顯多于女性。相較于二期梅毒和潛伏梅毒,神經(jīng)梅毒更多出現(xiàn)于一期梅毒。神經(jīng)梅毒的發(fā)生與梅毒的治療方式?jīng)]有明顯關(guān)系。對(duì)于血清RPR滴度≥1：32的血清固定患者,其發(fā)展為神經(jīng)梅毒的可能性明顯高于血清RPR滴度1：32的患者。
[Abstract]:Research background Syphilis is one of the most important human diseases, and still affects the global public health. However, with the increasing incidence of syphilis, more and more patients have no negative serological test after treatment. This phenomenon is called serum fixation. Therefore, serum fixation has been paid more and more attention. However, the cause of syphilis serum fixation is not fully understood. However, it is widely accepted that if serum fixation occurs in patients, reinfection or recurrence (treatment of irregular or azithromycin resistant strains) should be excluded first, and latent infections such as neurosyphilis should be excluded. Purpose Patients with serum fixation were examined for neurosyphilis by cerebrospinal fluid examination. The clinical, serological and epidemiological data of these patients were also reviewed. The incidence of neurosyphilis in these patients was analyzed. The relationship between the occurrence of neurosyphilis and treatment, the stage of syphilis and the titer of serum was discussed. Materials and methods From November 2008 to February 2010, patients with syphilis in our department of dermatology were collected. Meet the following condition: a. Both TPPA and RPR were positive for syphilis. RPR titer did not turn negative 6 months after early syphilis treatment or 12 months after late syphilis treatment. After excluding connective tissue disease, pregnancy and infection, they are admitted to the group. The cerebrospinal fluid (CSF) was collected from the patients. The RPR and IgG oligoclonal bands were analyzed and the history was collected. Result There were 63 patients (21 males and 42 females) with fixed serum in the group, and the number of females was significantly higher than that of males. There were 8 cases of neurosyphilis, the incidence rate was 12.70%, male 7 cases, female 1 case, male was obviously more than female. There were 5 cases of primary syphilis, including 3 cases of neurosyphilis. There were 10 cases of secondary syphilis and 1 case of neurosyphilis. There were 48 cases of latent syphilis, including 4 cases of neurosyphilis. The exact probabilistic test found that neurosyphilis was more common in primary syphilis. The primary, secondary and latent syphilis accounted for 18.18% and 75.00% of the patients with serum fixation, respectively, indicating that the more advanced syphilis, the more likely it is to develop to serum fixation. There were 23 cases of penicillin regular treatment, 13 cases of ceftriaxone sodium regular treatment and 3 cases of macrolide regular treatment. Conclusion Among the syphilis patients with fixed serum, 21 cases were males and 42 cases were females, and females were more likely to detect latent syphilis selectively than males. The occurrence of serum fixation is related to the stage of syphilis, and the more advanced syphilis, the more likely it is. The incidence of neurosyphilis was 12.70%, male 7 cases, female 1 case, male significantly more than female. Neurosyphilis is more common in primary syphilis than in secondary and latent syphilis. The occurrence of neurosyphilis has no obvious relationship with the treatment of syphilis. For patients with serum RPR titer 鈮，

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