摘要
目的探讨脑脊液寡克隆区带(OB)检测在神经梅毒患者诊断中的临床意义。方法收集2018年6月至2018年12月于首都医科大学附属北京地坛医院初诊、未经治疗的HIV阴性梅毒患者共163例。入组患者跟根据诊断结果分为隐性梅毒组(39例)、无症状神经梅毒组(43例)和有症状神经梅毒组(81例)。应用等电聚焦电泳联合免疫固定法检测入组患者脑脊液及血清OB,并判定脑脊液OB阳性结果。比较隐性梅毒和神经梅毒患者OB阳性率的差异,同时分析OB阳性和阴性神经梅毒患者的脑脊液生化、常规指标的差异,并通过ROC曲线评估脑脊液OB诊断神经梅毒的效能。结果入组163例梅毒患者中97例脑脊液OB阳性。隐性梅毒组、无症状神经梅毒组和有症状神经梅毒组患者脑脊液OB阳性率分别为12.8%(5/39)、65.1%(28/43)和79.0%(64/81)。有症状[64(79.0%)]及无症状神经梅毒[28(65.1%)]患者脑脊液OB阳性率显著高于隐性梅毒患者[5(12.8%)],差异有统计学意义(Bonferroni校正,P<0.0167)。有症状神经梅毒亚型的OB阳性率分别为脊髓痨93.3%(14/15),麻痹性痴呆89.5%(34/38),脑膜血管型81.8%(9/11)和眼梅毒41.2%(7/17)。以眼梅毒OB阳性率最低,且与麻痹性痴呆、脊髓痨间差异有统计学意义(Bonferroni校正,P<0.008)。晚期神经梅毒患者OB阳性率(90.6%、48/53)显著高于早期神经梅毒(68.5%、37/54)患者,差异有统计学意义(χ^2=7.96、P=0.005)。OB阳性神经梅毒患者IgG指数及脑脊液白细胞、IgG、IgG合成率、总蛋白较OB阴性患者显著升高。脑脊液OB阳性诊断神经梅毒的特异性和灵敏度分别为87.2%和74.2%,与本研究采用的神经梅毒诊断“金标准”一致率为78.6%,ROC曲线下面积为0.81。结论与隐性梅毒相比,神经梅毒患者脑脊液OB阳性率显著升高,提示脑脊液OB可能对神经梅毒有一定的辅助诊断价值。脑脊液OB能够反映中枢神经系统体液免疫,为脑脊液OB检测在神经梅毒诊断中的应用提供一定的客观依据。
Objective To investigate the clinical significance of oligoclonal bands(OB)in the diagnosis of neurosyphilis.Methods Total of 163 HIV-negative syphilis patients who first diagnosed and untreated were enrolled in Capital Medical University,Beijing Ditan Hospital from June 2018 to December 2018.The patients were divided into latent syphilis group(39 cases),asymptomatic neurosyphilis group(43 cases)and symptomatic neurosyphilis group(81 cases).Cerebrospinal fluid and serum OB were detected by isoelectric focusing combined with silver staining in all enrolled patients,and the positive result of cerebrospinal fluid OB was determined.The difference in OB positive rate between latent syphilis and neurosyphilis patients was compared.The biochemical and routine indexes differences of cerebrospinal fluid between OB positive and negative neurosyphilis patients were analyzed.The efficacy of OB in the diagnosis of neurosyphilis was evaluated by ROC curve.Results Total of 163 patients were enrolled,among whom,97 cases were detected for OB positive in cerebrospinal fluid.The positive rates of OB were 12.8%(5/39),65.1%(28/43)and 79.0%(64/81)in latent syphilis group,asymptomatic neurosyphilis group and symptomatic neurosyphilis group,respectively.The positive rates of OB in cases of asymptomatic neurosyphilis group[28(65.1%)]and symptomatic neurosyphilis group[64(79.0%)]were significantly higher than that of latent syphilis group[5(12.8%)],with significant difference(Bonferroni correction,P<0.0167).The positive rates of OB in all subtypes of symptomatic neurosyphilis were 93.3%(14/15)for tabes dorsalis,89.5%(34/38)for general paresis,81.8%(9/11)for meningovascular neurosyphilis and 41.2%(7/17)for ocular syphilis.The OB positive rate of ocular syphilis was the lowest among symptomatic neurosyphilis subtypes,and was significantly different compared with general paresis and tabes dorsalis(Bonferroni correction,P<0.008).The positive rate of OB in late neurosyphilis(90.6%,48/53)was significantly higher than that of early neurosyphilis(68.5%,37/54),with significant difference(χ^2=7.96,P=0.005).The levels of IgG index and cerebrospinal fluid leukocyte,IgG,IgG synthesis rate,and total protein increased significantly in OB positive neurosyphilis patients compared with those of OB negative neurosyphilis patients.The specificity and sensitivity of OB positive in cerebrospinal fluid in the diagnosis of neurosyphilis were 87.2%and 74.2%,respectively.Compared with the“gold standard”for the diagnosis of neurosyphilis used in this study,the consistency rate was 78.6%.The area under the ROC curve was 0.81.Conclusions Compared with latent syphilis,the positive rate of OB in neurosyphilis increased significantly,suggesting that OB may have a certain diagnostic value for neurosyphilis.OB of cerebrospinal fluid could reflect the immunity of the central nervous system,and providing a certain objective basis for the application of cerebrospinal fluid OB in neurosyphilis.
作者
许东梅
高俊华
张磊
秦开宇
姜美娟
伦文辉
Xu Dongmei;Gao Junhua;Zhang Lei;Qin Kaiyu;Jiang Meijuan;Lun Wenhui(Department of Neurology,Beijing Ditan Hosipital,Capital Medical University,Beijing 100015,China;Department of Dermatology and Venereology,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
2020年第3期241-246,共6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”(No.DTQH201402)。
关键词
梅毒
神经梅毒
寡克隆区带
Syphilis
Neurosyphilis
Oligoclonal bands
