高基线C反应蛋白水平可预测活动性梅毒患者发生吉海反应。
High Baseline C-Reactive Protein Level Can Predict the Occurrence of the Jarisch-Herxheimer Reaction in Patients with Active Syphilis.
作者信息
Tseng Yu-Ting, Chou Pei-Yun, Tai Ming-Hong, Dai Chia-Yen, Lee Susan Shin-Jung, Chen Yao-Shen, Tsai Hung-Chin, Chen Yen-Hsu
机构信息
Division of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
出版信息
Infect Drug Resist. 2021 Dec 2;14:5121-5129. doi: 10.2147/IDR.S335121. eCollection 2021.
BACKGROUND
The Jarisch-Herxheimer reaction (JHR) is an inflammatory reaction that can occur after treatment for syphilis. The mechanism of JHR is unknown. The level of C-reactive protein (CRP) increases during infection and inflammation. We hypothesized that CRP may be involved in the JHR in syphilitic patients at initial syphilis infection and also through interactions with benzathine penicillin-induced phagocytosis.
METHODS
This prospective cohort study enrolled syphilitic adult patients with/without JHR between July 2018 and October 2020. Serum samples before and after the administration of the first dose of benzathine penicillin were obtained. The serum level of CRP was determined by ELISA. The Kruskal-Wallis test was used to compare the levels of CRP in different groups, and the Wilcoxon signed-rank test was used to compare changes in CRP before and after benzathine penicillin treatment.
RESULTS
Twenty-nine syphilitic patients and three control groups (10 men who have sex with men (MSM) taking pre-exposure prophylaxis, 10 HIV-infected patients without syphilis, and 12 HIV-infected patients with previous syphilis) were enrolled. All 29 syphilitic patients were MSM, and 21 patients (72%) were infected with HIV. Overall, 41% (12/29) of the patients developed the JHR. The active syphilis groups had significantly higher serum levels of CRP (median 11,761 ng/mL, IQR 2986-19,061 ng/mL). There were no significant differences in the serum levels of CRP before or after benzathine penicillin treatment. The 12 patients with the JHR had significantly higher CRP levels before benzathine penicillin treatment (16,262 ng/mL [IQR 12,033-26,150 ng/mL] vs 3489 ng/mL [IQR 924-160,640] ng/mL, p = 0.0059, 95% CI 4002-17,098 ng/mL, area under the curve 0.799, 95% CI 0.632-0.966, sensitivity 1, specificity 0.647, with a CRP cut-off value of 4569.32 ng/mL).
CONCLUSION
A high baseline CRP level can predict the occurrence of the JHR in syphilitic patients treated with benzathine penicillin.
背景
雅里希-赫克斯海默反应（JHR）是梅毒治疗后可能发生的一种炎症反应。JHR的机制尚不清楚。C反应蛋白（CRP）水平在感染和炎症期间会升高。我们推测CRP可能在梅毒初发感染患者的JHR中起作用，并且也通过与苄星青霉素诱导的吞噬作用相互作用而发挥作用。
方法
这项前瞻性队列研究纳入了2018年7月至2020年10月期间有/无JHR的成年梅毒患者。采集了第一剂苄星青霉素给药前后的血清样本。通过酶联免疫吸附测定法测定血清CRP水平。采用Kruskal-Wallis检验比较不同组的CRP水平，采用Wilcoxon符号秩检验比较苄星青霉素治疗前后CRP的变化。
结果
共纳入29例梅毒患者和3个对照组（10名接受暴露前预防的男男性行为者（MSM）、10名未感染梅毒的HIV感染者和12名既往感染过梅毒的HIV感染者）。所有29例梅毒患者均为MSM，21例（72%）感染了HIV。总体而言，41%（12/29）的患者发生了JHR。活动性梅毒组的血清CRP水平显著更高（中位数为11,761 ng/mL，四分位间距为2986 - 19,061 ng/mL）。苄星青霉素治疗前后血清CRP水平无显著差异。12例发生JHR的患者在苄星青霉素治疗前的CRP水平显著更高（16,262 ng/mL[四分位间距为12,033 - 26,150 ng/mL] vs 3489 ng/mL[四分位间距为924 - 160,640] ng/mL，p = 0.0059，95%置信区间为4002 - 17,098 ng/mL，曲线下面积为0.799，95%置信区间为0.632 - 0.966，敏感性为1，特异性为0.647，CRP临界值为4569.32 ng/mL）。
结论
高基线CRP水平可预测接受苄星青霉素治疗的梅毒患者发生JHR。
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