Ghanem Khalil G, Moore Richard D, Rompalo Anne M, Erbelding Emily J, Zenilman Jonathan M, Gebo Kelly A
Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.
AIDS. 2008 Jun 19;22(10):1145-51. doi: 10.1097/QAD.0b013e32830184df.
To describe the risk factors, clinical presentation, and long-term follow up of patients enrolled in a clinical cohort of HIV-infected patients who were diagnosed and treated for neurosyphilis.
Comprehensive demographic, clinical, and therapeutic data were collected prospectively on all patients between 1990 and 2006. Patients were diagnosed with neurosyphilis if they had positive syphilis serologies and any of the following: (a) one or more cerebrospinal fluid abnormalities on lumbar puncture [white blood cells >10/microl; protein >50 mg/dl; reactive venereal diseases research laboratory], (b) an otherwise unexplained neurological finding.
Of 231 newly diagnosed syphilis cases, 41 neurosyphilis cases met entry criteria (median age 38.6 years, 79.1% male). Risk factors for neurosyphilis included a CD4 cell count of less than 350 cells/ml at the time of syphilis diagnosis (odds ratio: 2.87; 95% confidence interval: 1.18-7.02), a rapid plasma regain titer >1: 128 (2.83; 1.11-7.26), and male sex (2.46; 1.06-5.70). Use of any highly active antiretroviral therapy before syphilis infection reduced the odds of neurosyphilis by 65% (0.35; 0.14-0.91). Sixty-three percent of cases presented with early neurosyphilis and the median time to neurosyphilis diagnosis was 9 months. Symptomatic patients had more cerebrospinal fluid abnormalities on initial lumbar puncture than asymptomatic patients (P = 0.01). Follow-up lumbar puncture within 12 months revealed that only 38% had resolution of all cerebrospinal fluid abnormalities. At 1 year, 38% had persistence of their major symptom despite adequate treatment for neurosyphilis. Twelve of 41 (29%) patients were retreated for syphilis.
Early neurosyphilis was common in this cohort. Highly active antiretroviral therapy to reverse immunosuppression may help mitigate neurological complications of syphilis.
描述纳入梅毒感染合并神经梅毒临床队列患者的危险因素、临床表现及长期随访情况。
前瞻性收集1990年至2006年间所有患者的全面人口统计学、临床及治疗数据。若患者梅毒血清学检查呈阳性且有以下情况之一，则诊断为神经梅毒：(a) 腰椎穿刺脑脊液有一项或多项异常 [白细胞>10/微升；蛋白质>50毫克/分升；性病研究实验室反应性]，(b) 无法解释的神经系统表现。
在231例新诊断的梅毒病例中，41例神经梅毒病例符合入选标准（中位年龄38.6岁，79.1%为男性）。神经梅毒的危险因素包括梅毒诊断时CD4细胞计数低于350个/毫升（比值比：2.87；95%置信区间：1.18 - 7.02）、快速血浆反应素滴度>1:128（2.83；1.11 - 7.26）以及男性（2.46；1.06 - 5.70）。梅毒感染前使用任何高效抗逆转录病毒疗法可使神经梅毒的发病几率降低65%（0.35；0.14 - 0.91）。63%的病例表现为早期神经梅毒，神经梅毒诊断的中位时间为9个月。有症状的患者初次腰椎穿刺时脑脊液异常比无症状患者更多（P = 0.01）。12个月内的随访腰椎穿刺显示，只有38%的患者所有脑脊液异常均消失。1年时，尽管对神经梅毒进行了充分治疗，但仍有38%的患者主要症状持续存在。41例患者中有12例（29%）因梅毒接受了再次治疗。
早期神经梅毒在该队列中很常见。通过高效抗逆转录病毒疗法逆转免疫抑制可能有助于减轻梅毒的神经系统并发症。
