摘要
目的探讨夫妻共同感染梅毒螺旋体后临床表型及实验室指标差异。方法收集2015年3月至2021年7月于首都医科大学附属北京地坛医院首次诊治且人类免疫缺陷病毒(HIV)阴性的共同感染梅毒螺旋体夫妻32对。根据我国2020年梅毒和神经梅毒最新诊断标准分为症状神经梅毒(NS)-无症状NS夫妻组17对,NS-隐性梅毒夫妻组15对。分别比较两组患者夫妻间年龄、性别、外周血淋巴细胞计数和比值、梅毒血清学指标、脑脊液(CSF)白细胞(WBC)计数、蛋白(Pro)定量和葡萄糖(Glu)浓度、CSF梅毒相关指标等差异,通过条件Logistic回归分析影响夫妻间临床表型差异的因素。结果在症状NS-无症状NS夫妻组中,无症状NS患者T淋巴细胞计数较症状NS患者高(t=-2.184、P=0.047),无症状NS患者CD4^(+)T(t=-2.088、P=0.056)和CD8^(+)T(t=-2.112、P=0.053)淋巴细胞计数高于症状NS患者,但差异无统计学意义;症状NS患者CSF TRUST滴度(Z=-2.124、P=0.034)和CSF Pro定量(Z=-3.006、P=0.003)高于无症状NS患者;条件Logistic回归分析显示,男性患者更易表现为症状NS(OR=14.000、95%CI:1.841~106.465、P=0.011)。NS-隐性梅毒夫妻组中,NS患者淋巴细胞(t=2.322、P=0.040)、T淋巴细胞(t=2.385、P=0.036)和CD8^(+)T淋巴细胞计数(t=2.801、P=0.017),CSF Pro定量(Z=-2.062、P=0.039)及血清TRUST滴度(Z=-3.000、P=0.003)均显著高于隐性梅毒患者;条件Logistic回归分析显示CD8^(+)T淋巴细胞计数高的患者更易表现为NS,但差异无统计学意义(OR=1.008、95%CI:0.998~1.018、P=0.130)。结论当夫妻双方共患NS时,男性表现为症状NS的风险高于女性,夫妻间T淋巴细胞计数,血清和CSF TRUST滴度,CSF Pro等实验室指标差异可能与机体的免疫应答和炎症反应有关。
Objective To explore the differences of clinical phenotypes and laboratory parameters between couples after co-infection with treponema pallidum.MethodsTotal of 32 HIV-negative couples co-infected with treponema pallidum were enrolled,who were first diagnosed and treated in Beijing Ditan Hospital,Capital Medical University,from March 2015 to July 2021.These couples were divided into groups of symptomatic neurosyphilis-asymptomatic neurosyphilis(17 couples)and neurosyphilis(NS)-latent syphilis(15 couples)according to the latest diagnostic criteria for syphilis and neurosyphilis of China in 2020.The age,gender,peripheral blood lymphocyte count and ratio,serological syphilis indexes,also white blood cell(WBC)count,protein(Pro)quantification,glucose(Glu)concentration and syphilis indexes of cerebrospinal fluid(CSF)were compared between couples of the two groups,respectively.The factors affecting the differences of clinical phenotypes between couples were analyzed by Conditional Logistic Regression.ResultsIn the symptomatic NS-asymptomatic NS group,the T lymphocyte count of asymptomatic NS patients was higher than that of symptomatic NS patients(t=-2.184,P=0.047).Asymptomatic NS patients had higher CD4^(+)T(t=-2.088,P=0.056)and CD8^(+)T(t=-2.112,P=0.053)lymphocyte counts than those of symptomatic NS patients,but the difference was not statistically significant;the CSF TRUST titer(Z=-2.124,P=0.034)and CSF Pro quantification(Z=-3.006,P=0.003)of symptomatic NS patients were higher than those of asymptomatic NS patients;Conditional Logistic Regression analysis showed that male patients were more likely to present as symptomatic NS(OR=14.000,95%CI:1.841-106.465,P=0.011).In the NS-latent syphilis group,the counts of lymphocytes(t=2.322,P=0.040),T lymphocytes(t=2.385,P=0.036)and CD8^(+)T lymphocytes(t=2.801,P=0.017),CSF Pro quantification(Z=-2.062,P=0.039)and serum TRUST titer(Z=-3.000,P=0.003)of NS patients were significantly higher than those of latent syphilis patients;Conditional Logistic Regression analysis showed that patients with higher CD8^(+)T lymphocyte count were more likely to present as NS,but there was no statistical significance(OR=1.008,95%CI:0.998-1.018,P=0.130).ConclusionsIf the couple both suffer from NS,men have a higher risk to develop into symptomatic NS than women.Differences in T lymphocyte counts,serum and CSF TRUST titers,CSF Pro and other laboratory indexes between the couple may be related to the immune response and inflammatory reaction of human body.
作者
师璐
黄宇明
寇程
秦开宇
吴雅丽
马小扬
许东梅
Lu Shi;Yuming Huang;Cheng Kou;Kaiyu Qin;Yali Wu;Xiaoyang Ma;Dongmei Xu(Department of Neurology,Beijing Ditan Hosipital,Capital Medical University,Beijing 100015,China)
出处
《中华实验和临床感染病杂志（电子版）》
CAS
2022年第5期328-336,共9页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
基金
首都医科大学附属北京地坛医院院内科研基金"启航计划"项目(No.DTQH201607)
关键词
梅毒
神经梅毒
夫妻共同感染
影响因素
免疫反应
Syphilis
Neurosyphilis
Couple co-infection
Influencing factor
Immune response
作者简介
通信作者:许东梅,Email:xdmlb@163.com
