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目的探讨神经梅毒血清甲苯胺红不加热血清反应素试验(toluidine red unheated serum test,TRUST)与其他检测指标的相关性,分析神经梅毒的危险因素。方法 171例疑似梅毒患者,确诊为神经梅毒患者73例为观察组,非神经梅毒患者98例为对照组,比较2组一般资料、神经系统症状、血清TRUST滴度、脑脊液梅毒螺旋体明胶颗粒凝聚试验(treponema pallidum particle agglutination,TPPA)、脑脊液TRUST滴度、脑脊液压力、脑脊液白细胞计数、脑脊液蛋白水平,分析血清TRUST滴度与其他指标的相关性,分析神经梅毒发生的危险因素及血清TRUST滴度对神经梅毒的诊断效果。结果观察组男性比率(50.7%)、年龄[(49.7±7.8)岁]、神经系统症状比率(75.3%)、脑脊液白细胞计数[(35.9±8.1)×106/L]、脑脊液蛋白[(617±126)mg/L]、血清TRUST阳性率(100.0%)、血清TRUST滴度[1∶(51.7±5.7)]、脑脊液TRUST阳性率(100.0%)、脑脊液TRUST滴度[1∶(4.1±1.7)]高于对照组[14.3%、(39.4±12.5)岁、8.2%、(2.8±0.6)×106/L、(224±35)mg/L、72.4%、1∶(12.8±3.7)、0、1∶(0.0±0.0)](P<0.05);血清TRUST滴度与脑脊液TRUST滴度、脑脊液蛋白呈正相关(r=0.310,P=0.006;r=0.318,P=0.000);高脑脊液TRUST滴度、脑脊液TPPA阳性、脑脊液蛋白增高均为神经梅毒的危险因素(OR=3.043,95%CI:1.538~12.815,P=0.031;OR=7.523,95%CI:1.178~81.415,P=0.004;OR=20.389,95%CI:8.533~252.158,P=0.017);当血清TRUST滴度检测神经梅毒的最佳截断值为1∶16时,AUC为0.828(95%CI:0.767~0.889,P=0.000),灵敏度为68.5%,特异度为84.7%,约登指数为0.532。结论神经梅毒血清TRUST滴度与脑脊液TRUST滴度、脑脊液蛋白呈正相关;高脑脊液TRUST滴度、脑脊液TPPA阳性、脑脊液蛋白增高均是神经梅毒发生的危险因素。
Objective To investigate the correlation between serum syphilis toluidine red unheated serum test (TRUST) and other test indexes and to analyze the risk factors of neurosyphilis. Methods A total of 171 patients with suspected syphilis were diagnosed as neurosyphilis, 73 as non-neurosyphilis patients and 98 patients with non-neurosyphilis as control group. The general data, neurological symptoms, serum TRUST titer, CSF coagulation test of Treponema pallidum (TPPA), TRUST titers of cerebrospinal fluid, cerebrospinal fluid pressure, cerebrospinal fluid leukocyte count, cerebrospinal fluid protein level, serum TRUST titers and other indicators of the correlation analysis of risk factors of neurosyphilis and serum TRUST titer Diagnosis of neurosyphilis. Results The ratio of male in observation group (50.7%), age (49.7 ± 7.8) years old, nervous system symptom rate (75.3%), cerebrospinal fluid leukocyte count (35.9 ± 8.1) × 106 / L and cerebrospinal fluid protein (100.0%), serum TRUST titer [1:51 (51.7 ± 5.7)], positive rate of TRUST in cerebrospinal fluid (100.0% ) Were higher than those in the control group (14.3%, (39.4 ± 12.5) years, 8.2%, (2.8 ± 0.6) × 106 / L, (224 ± 35) mg / L, 72.4%, 1: (12.8 ± 3.7) 0,1: (0.0 ± 0.0)] (P <0.05). TRUST titer in serum was positively correlated with CSF TRUST titer and cerebrospinal fluid protein (r = 0.310, P = 0.006; r = 0.318, P = 0.000) TRUST titer, cerebrospinal fluid TPPA positive and cerebrospinal fluid protein were all risk factors of neurosyphilis (OR = 3.043, 95% CI: 1.538-12.815, P = 0.031; OR = 7.523, 95% CI: 1.178-81.415, P = 0.004 ; OR = 20.389, 95% CI: 8.533 ~ 252.158, P = 0.017); AUC of 0.828 (95% CI: 0.767-0.889, P = 0.000), the sensitivity was 68.5%, the specificity was 84.7% and the Youden index was 0.532. Conclusion TRUST titer of neurosyphilis serum is positively correlated with TRUST titer of cerebrospinal fluid and protein of cerebrospinal fluid. TRUST titer of high cerebrospinal fluid, positive of cerebrospinal fluid (TPPA) and protein of cerebrospinal fluid are the risk factors of neurosyphilis.