發(fā)布時間：2019-03-22 18:00

【摘要】： 目的探討引起梅毒血清固定的可能原因 方法通過對20例梅毒血清固定患者進(jìn)行腦脊液(CSF)常規(guī)、生化檢測及RPR、TPPA測定,同時檢測外周血細(xì)胞免疫和體液免疫功能以及內(nèi)臟多器官影像學(xué)檢查。所有患者均按照神經(jīng)梅毒規(guī)范治療,分別于三月后復(fù)查外周血RPR定量試驗。 結(jié)果本組20例患者中有4例(20.0%)CSF-TPPA(+),其中1例CSF-RPR(+),未發(fā)現(xiàn)CSF中有蛋白及白細(xì)胞增高。2例(10.0%)外周血IgM水平升高、C 3降低,14例(70.0%)患者細(xì)胞毒/抑制T細(xì)胞(CD8/3)增加、輔助/誘導(dǎo)記憶T細(xì)胞(CD4/3)減少。3例(15.0%)心臟彩超分別發(fā)現(xiàn)左室松弛減退,主動脈瓣回聲稍強和二尖瓣退行性變。5例(25.0%)腦CT、MRI發(fā)現(xiàn)腦萎縮及多發(fā)腔隙灶。根據(jù)病史18例(90.0%)于不潔性交史后超過半年以上的時間才開始規(guī)范化治療,初始使用使用芐星青霉素240萬U/周,連續(xù)3次治療。2例(10.0%)使用美滿霉素或者阿奇霉素。確診為血清固定后,均按神經(jīng)梅毒治療方案治療后3個月所有患者血清RPR滴度未降低。 結(jié)論治療未能及時、選藥不當(dāng)、潛在器官梅毒和免疫異�？赡苁且鹈范净颊哐骞潭ǖ脑�。
[Abstract]:Objective to explore the possible causes of syphilis serofixation methods routine, biochemical and RPR,TPPA tests of cerebrospinal fluid (CSF) were performed in 20 patients with syphilis serum fixation. Meanwhile, peripheral blood cell immunity and humoral immune function as well as imaging examination of visceral multiple organs were detected. All the patients were treated according to the criteria of neurosyphilis. The peripheral blood RPR quantitative test was reexamined three months later. Results among the 20 patients, 4 (20.0%) cases were CSF-TPPA (), 1 case (CSF-RPR (),) had no increase in protein and leukocyte in CSF, 2 cases (10.0%) had increased IgM level in peripheral blood, and C 3 decreased, but there was no significant difference between two cases (10.0%) and the control group (P < 0.05). Cytotoxic / inhibitory T cells (CD8/3) increased and helper / induced memory T cells (CD4/3) decreased in 14 patients (70.0%), left ventricular relaxation was found in 3 patients (15.0%), and left ventricular relaxation was decreased in 3 patients (15.0%). In 5 cases (25.0%), cerebral atrophy and multiple lacunar foci were found on CT,MRI. According to the history of 18 cases (90.0%), more than half a year after the history of unclean sexual intercourse began standardized treatment, the initial use of benzylpenicillin 2.4 million U / week. Two cases (10.0%) were treated with methamphenicol or azithromycin. The serum RPR titers of all patients did not decrease 3 months after treatment according to neurosyphilis treatment. Conclusion the failure of treatment in time, improper selection of drugs, potential organ syphilis and immune abnormalities may be the causes of serum fixation in syphilis patients.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R759.1

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