HIV陽性與HIV陰性神經梅毒臨床特點的比較

閆俊　　王夢嫣　　張忠東　　師金川　　張斌海　　萬虎　　楊宗興

[關鍵詞] 人類免疫缺陷病毒;非人類免疫缺陷病毒;神經梅毒;臨床特點

[中圖分類號] R759.13? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-9701（2021）21-0022-04

Comparison of clinical features between HIV-positive and HIV-negative neurosyphilis

YAN Jun? ?WANG Mengyan? ?ZHANG Zhongdong? ?SHI Jinchuan? ?ZHANG Binhai? ?WAN Hu? ?YANG Zongxing

Department Ⅱ of Infectious Disease， Xixi Hospital of Hangzhou City， Hangzhou? ?310023， China

[Abstract] Objective To compare the clinical features of HIV-positive and HIV-negative neurosyphilis. Methods Patients with HIV-positive and HIV-negative neurosyphilis admitted to our hospital from January 2013 to December 2019 were retrospectively included. Clinical data such as general condition， history of syphilis treatment， course of disease， laboratory test results， and neurosyphilis classification of patients were collected and analyzed statistically. Results There were 375 cases in the HIV-positive group and 141 cases in the HIV-negative group. There were 363 males （96.80%） in the HIV-positive group， which were more than that of 92 males （65.25%） in the HIV-negative group （P<0.001）， and the median age in the HIV-positive group was 35 （30， 42） years， which was younger than that of 56 （48， 64） years in the HIV-negative group （P<0.001）. 282 cases （75.20%） in the HIV-positive group had a reciprocal RPR titer of Log2≥32， which was more than that of 67 cases （45.16%） in the HIV-negative group （P<0.001）. In the HIV-positive group， 260 cases （53.33%） with positive TPPA in cerebrospinal fluid and 53 cases （14.13%） with reciprocal RPR titer ≥ 1 in Log2 cerebrospinal fluid were less than those of 131 cases （92.91%） and 72 cases （51.06%） in the HIV-negative group （P<0.001）. Glucose and chloride in CSF in the HIV-positive group were lower than those in the HIV-negative group （P<0.001）. There were 345 cases （92.00%） asymptomatic neurosyphilis in the HIV-positive group， which were more than that of 60 cases （42.55%） in the HIV-negative group （P<0.001）. There were 8 cases （2.13%） of cerebrovascular inflammation and 7 cases （1.87%） of brain parenchyma in the HIV-positive group， which were less than those of 22 cases （15.60%） and 56 cases （39.72%） in the HIV-negative group （P<0.001）. Conclusion Male patients with HIV-positive neurosyphilis， blood RPR>1∶32 and asymptomatic neurosyphilis were all more than those with HIV-negative neurosyphilis. However， the age， TPPA positive rate in cerebrospinal fluid， RPR positive rate， cell number， protein， glucose， chloride， cerebrovascular type and cerebral parenchyma type of HIV-negative neurosyphilis were all higher than those of the HIV-positive patients.