早期神经梅毒治疗前后脑脊液检测临床分析

摘要

目的 探讨早期神经梅毒患者应用头孢曲松钠及水剂青霉素治疗前后的脑脊液变化情况.方法 选取2008年1月至2013年12月青岛大学医学院附属青岛市市立医院32例神经梅毒患者,按住院号末位奇偶数字分为头孢曲松钠组(17例)和水剂青霉素组(15例).均住院接受治疗,头孢曲松钠组予头孢曲松钠2.0 g/d静脉滴注,连续14 d;水剂青霉素组给予水剂青霉素400万U/次,1次/4h,静脉滴注,连续14 d,继以苄星青霉素G 240万U肌内注射,1次/周,共3次.分别于治疗后6、12、18个月进行血清学及脑脊液随访检查,观察比较2组治疗前后血清及脑脊液快速血浆反应素环状卡片试验(RPR)滴度、脑脊液白细胞计数(WBC)、脑脊液蛋白定量变化及不良反应发生情况.结果 治疗后6个月,头孢曲松钠组和水剂青霉素组血清学RPR滴度分别有16例(94.1％)、14例(93.3％)出现不同程度的下降,其中分别有7例(41.2％)、7例(46.7％)下降4倍及以上,组间差异无统计学意义(x2=0.098,P=0.755);脑脊液RPR滴度分别有9例(52.9％)、8例(53.3％)出现下降,组间差异无统计学意义(x2=0.000,P=0.982).2组脑脊液WBC分别有11例(64.7％)、10例(66.7％)降至10×106/L以下,差异无统计学意义(x2=0.014,P=0.907).治疗后12个月,2组分别有14例(82.4％)、13例(86.7％)血清学及脑脊液RPR同时转阴,差异无统计学意义(x2 =0.112,P=0.737);分别有15例(88.2％)、14例(93.3％)脑脊液WBC降至10×106/L以下,差异无统计学意义(x2=0.244,P=0.621);同时脑脊液RPR转阴、WBC降至10×106/L以下分别有13例(76.5％)、13例(86.7％),差异无统计学意义(x2=0.544,P=0.461).治疗后18个月,2组分别有16例(94.1％)、14例(93.3％)血清学及脑脊液RPR同时转阴,差异无统计学意义(x2=0.008,P=0.927);同时脑脊液RPR转阴、WBC降至5×106/L以下分别有11例(64.7％)、12例(80.0％),差异无统计学意义(x2=0.922,P=0.337).所有患者治疗期间未发生吉海反应.结论 头孢曲松钠可作为治疗早期神经梅毒的有效替代药物,血清及脑脊液RPR滴度的变化可用于神经梅毒疗效的评估.%Objective To detect the changes of cerebrospinal fluid (CSF) before and after treatment with ceftriaxone sodium and penicillin in early neurosyphilis.Methods Totally 32 patients with neurosyphilis from January 2008 to December 2013 were randomly divided into ceftriaxone sodium group (17 cases) administrated with intravenous dripping of ceftriaxone sodium (2.0 g/d,14 days) and aqueous penicillin group (15 cases) administrated with intravenous dripping of penicillin (4 million unit,1 time/4 h,14 days) followed by intramuscular injection of benzylpenicillin G (2.4 million unit,1 time/week,3 times).The serum and CSF detections,including titer of rapid plasma regain card test (RPR),white blood cell count (WBC) in CSF,quantitative protein in CSF were compared between groups 6,12,and 18 months after treatment;the adverse reactions were observed.Results Six months after treatment,the serum RPR titer decreased in 16 cases (94.1％) in ceftriaxone sodium group and in 14 cases (93.3％) in penicillin group,among them,the serum RPR titer decreased by 4 times and more in 7 cases (41.2％) in ceftriaxone sodium group and 7 cases (46.7％) in penicillin group,without significant difference between groups (x2 =0.098,P =0.755);the CSF RPR titer decreased in 9 case (52.9％) in ceftriaxone sodium group and in 8 cases (53.3％) in penicillin group,without significant difference between groups (x2 =0.000,P =0.982);the WBC in CSF decreased to ＜ 10 × 106/L in 11 cases (64.7％) in ceftriaxone sodium group and in 10 cases (66.7％) in penicillin group,without significant difference between groups (x2 =0.014,P =0.907).Twelve months after treatment,the serum and CSF RPR both turned negative in 14 cases (82.4％) in ceftriaxone sodium group and in 13 cases (86.7％) in penicillin group,without significant difference between groups (x2 =0.112,P =0.737);the WBC in CSF decreased to ＜ 10 × 106/L in 15 cases (88.2％) in cefiriaxone sodium group and in 14 cases (93.3％) in penicillin group,without significant difference between groups (x2 =0.244,P =0.621);both CSF RPR turned negative and WBC in CSF decreased to ＜ 10 × 106/L in 13 cases (76.5％) in ceftriaxone sodium group and in 13 cases (86.7％),without significant difference between groups (x2 =0.544,P =0.461).Eighteen months after treatment,the serum and CSF RPR both turned negative in 16 cases (94.1％) in ceftriaxone sodium group and in 14 cases (93.3％) in penicillin group,without significant difference between groups (x2 =0.008,P =0.927);both CSF RPR turned negative and WBC in CSF decreased to ＜5 × 106/L in 11 cases (64.7％) in ceftriaxone sodium group and 12 cases (80.0％) in penicillin group,without significant difference between groups (x2 =0.922,P =0.337).No Jarisch-Herxheimer response occurred during treatment in all patients.Conclusion Ceftriaxone sodium can replace penicillin as an effective drug in treating early neurosyphilis;change of serum and cerebrospinal fluid RPR titer can be used to evaluate the efficacy.