Liu Li-Li, Zhang Hui-Lin, Huang Song-Jie, Liu Long, Tong Man-Li, Lin Li-Rong, Chen Yu-Yan, Xi Ya, Guo Xiao-Jing, Zhang Ya-Feng
Int Immunopharmacol. 2013 Dec;17(4):1120-4. doi: 10.1016/j.intimp.2013.10.008.
Neurosyphilis (NS) caused by Treponema pallidum (T. pallidum) subspecies pallidum, can affect the central nervous system during any stage of the disease. To assess several laboratory parameters for NS diagnosis, we performed a case control study on 42 hospitalized NS patients negative for human immunodeficiency virus (HIV) and 40 syphilis/non-NS patients, excluding NS patients at Xiamen Zhongshan Hospital from June 2010 to June 2011. Multivariate logistic regression model showed that the cerebrospinal fluid white blood cell (CSF-WBC, P = 0.009) levels, the CSF-LDH (P = 0.006) levels, the albumin quotient (P = 0.009) and the IgA index (P = 0.042) were independently associated with high risk of NS. The receiver operator characteristic (ROC) curve analysis revealed that the optimal cut-offs were 10 × 106 cells/L for the CSF-WBC concentration, 19.3 U/L for the CSF lactate dehydrogenase (LDH) concentration, 7.08 for the albumin quotient, and 0.14 for the IgA index. Combining the CSF-WBC level, the CSF-LDH level, the albumin quotient and the IgA index increased the NS diagnosis sensitivity to 97.6%. T. pallidum particle agglutination (TPPA) index significantly correlated with the CSF-WBC (r = 0.453, P = 0.000), the IgA index (r = 0.446, P = 0.000), the albumin quotient (r = 0.262, P = 0.017), and the CSF-LDH (r = − 0.278, P = 0.012), respectively. In addition, there were correlations between the CSF-WBC and the IgA index (r = 0.329, P = 0.003), and between the CSF-WBC and the albumin quotient (r = 0.306, P = 0.005). Our results indicated that simultaneous testing of CSF-WBC levels, albumin quotient, IgA index and CSF-LDH can help predict the likelihood of NS in HIV-negative patients.
由梅毒螺旋体苍白亚种引起的神经梅毒（NS）可在梅毒病程的任何阶段累及中枢神经系统。为评估多项用于NS诊断的实验室指标，我们对42例住院的人类免疫缺陷病毒（HIV）阴性的NS患者和40例梅毒/非NS患者进行了一项病例对照研究，研究对象排除了2010年6月至2011年6月期间在厦门中山医院的NS患者。多因素logistic回归模型显示，脑脊液白细胞（CSF-WBC，P = 0.009）水平、脑脊液乳酸脱氢酶（CSF-LDH，P = 0.006）水平、白蛋白商（P = 0.009）和IgA指数（P = 0.042）与NS的高风险独立相关。受试者工作特征（ROC）曲线分析显示，CSF-WBC浓度的最佳截断值为10×10⁶个细胞/L，脑脊液乳酸脱氢酶（LDH）浓度为19.3 U/L，白蛋白商为7.08，IgA指数为0.14。联合检测CSF-WBC水平、CSF-LDH水平、白蛋白商和IgA指数可将NS诊断敏感性提高至97.6%。梅毒螺旋体颗粒凝集试验（TPPA）指数分别与CSF-WBC（r = 0.453，P = 0.000）、IgA指数（r = 0.446，P = 0.000）、白蛋白商（r = 0.262，P = 0.017）和CSF-LDH（r = - 0.278，P = 0.012）显著相关。此外，CSF-WBC与IgA指数之间（r = 0.329，P = 0.003）以及CSF-WBC与白蛋白商之间（r = 0.306，P = 0.005）存在相关性。我们的结果表明，同时检测CSF-WBC水平、白蛋白商、IgA指数和CSF-LDH有助于预测HIV阴性患者发生NS的可能性。
