【作者】 王娟娟；

【导师】 季江；

【作者基本信息】 苏州大学 ， 皮肤病与性病学（专业学位）， 2020， 硕士

【摘要】 第一部分 以精神行为异常为首发症状的HIV阴性神经梅毒患者67例回顾性分析目的:总结首发症状为精神行为异常的HIV阴性神经梅毒患者的临床特征,为神经梅毒病程判断和疗效监测提供参考。方法:回顾性分析确诊病例的临床资料,部分采用SPSS 22.0统计学软件统计分析,P<0.05为差异有统计学意义。结果:67例患者中,男性52例(77.6%),女性15例(22.4%),中老年63例(94.0%),青少年4例(6.0%)。临床分型:麻痹性痴呆型38例(56.7%),脑膜血管型21例(31.3%),脊髓痨型3例(4.5%),脑膜型1例(1.5%),混合型4例(6.0%)。年龄、脑脊液蛋白、脑脊液IgG在不同类型神经梅毒中无显著性差异(P>0.05),脑脊液白细胞计数差异有显著性(F=23.7,P<0.05)。MRI检查中,有21例(31.3%)见多发缺血灶,17例(25.4%)有多发脑白质病变,其余可见脑萎缩(22.4%)、梗死灶(11.9%)、脑炎样改变(3.0%)等。67例患者均予抗感染药物治疗。6个月随访时,46例(68.7%)患者治疗有效。结论:首发症状为精神行为异常的HIV阴性神经梅毒患者以中老年男性居多,CSF实验室检查尤其白细胞计数对判断神经梅毒临床型别有一定的临床意义,MRI检查对神经梅毒临床分型和判断转归有帮助,尽早抗生素治疗促进疾病转归。第二部分 不同临床阶段神经梅毒与梅毒血清固定患者外周血Th1、Th2和Th17相关细胞因子分析目的:检测不同临床阶段神经梅毒与梅毒血清固定患者外周血Th1、Th2及Th17相关细胞因子表达水平,以了解患者细胞免疫相关因子状况。方法:收集苏州大学附属第二医院2017年9月-2019年10月期间确诊为神经梅毒的患者79例(包括无症状型6例,早期23例,晚期50例),血清固定患者65例,对照组(健康体检者)30例。采用酶联免疫吸附法检测各组外周血中Th1细胞因子(IL-2、IFN-γ)、Th2 细胞因子(IL-4、IL-6、IL-10)及 Th17 细胞因子(TNF、IL-17A)的表达水平,统计分析检测结果。结果:IL-2、IFN-γ、IL-4、IL-17A在神经梅毒、血清固定患者和对照组间的水平具有统计学差异(P<0.05)。神经梅毒和血清固定患者外周血IL-2、IFN-γ、IL-4高于对照组且IL-17A低于对照组,均具有统计学差异(P<0.05)。神经梅毒与血清固定患者外周血Th1、Th2、Th17相关细胞因子无显著性差异(p>0.05)。IL-2、IFN-γ、IL-4、IL-17A在不同临床阶段神经梅毒患者和对照组间的含量变化有统计学差异(P<0.05)。IL-17A在早期神经梅毒与对照组之间无显著性差异(P>0.05),晚期神经梅毒患者IL-17A低于对照组,差异有显著性(P<0.05)。结论:神经梅毒和血清固定患者免疫功能异常。不同阶段患者免疫状态存在差异。Th1、Th2及Th17类细胞因子参与神经梅毒和血清固定患者的免疫应答且存在平衡的异常。更多还原

【Abstract】 Chapter One A retrospective analysis of 67 cases of HIV-negative neurosyphilis patients with abnormal mental behavior as the first symptomObjective To summarize the clinical characteristics of HIV-negative neurosyphilis patients with abnormal mental behavior as the first symptom,and provide reference for the diagnosis of the course of neurosyphilis and the monitoring of its curative effect.Materials and Methods Clinical data of confirmed cases were retrospectively analyzed,and part of them were statistically analyzed by SPSS 22.0 statistical software.P<0.05 was considered statistically significant.Results Among the 67 patients,52 were males(77.6%),15 were females(224%),63 were middle-aged and elderly(94.0%),and 4 were adolescents(6.0%).There were 38 cases of paralytic dementia(56.7%),21 cases of meningeal vascular type(31.3%),3 cases of tuberculosis(4.5%),1 case of meningeal type(1.5%),and 4 cases of mixed type(6.0%).There was no significant difference in age,CSF protein,CSF IgG in different clinical types of neurosyphilis(P>0.05),and there was a significant difference in CSF white blood cell count(F=23.7,P<0.05).In MRI examination,21 cases(31.3%)had multiple ischemic foci,17 cases(25.4%)had multiple leukodystrophy,and the rest had cerebral atrophy(22.4%),infarction(11.9%),and encephalitis like changes(3.0%).All 67 patients were treated with antiinfective drugs.At 6 months follow-up,53 patients(79.1%)were effectively treated.Conclusion The majority of hiv-negative neurosyphilis patients with initial symptoms of abnormal mental behavior are middle-aged and elderly males.The laboratory examination of CSF is of significance in determining the clinical type of neurosyphilis,and the MRI examination is helpful in determining the clinical type and outcome of neurosyphilis.The early antibiotic treatment promotes the outcome of the disease.Chapter Two Analysis of Th1,Th2 and Th17 related cytokines in peripheral blood of patients with neurosyphilis and syphilis serofast at different clinical stagesObjective The expression levels of Th1,Th2 and Th17 related cytokines in peripheral blood of patients with neurosyphilis and syphilis sero-fixation at different clinical stages were detected to understand the status of cell-immune-related cytokines in patients.Materials and Methods A total of 79 patients(including 6 asymptomatic patients,23 patients in the early stage and 50 patients in the late stage)diagnosed with neurosyphilis from September 2017 to October 2019 in our hospital were collected,including 65 patients with serum fixation and 30 patients in the control group(healthy subjects).The expression levels of Th1 cytokines(Il-2,IFN-γ),Th2 cytokines(IL-4,IL-6,IL-10)and Th17 cytokines(TNF,IL-17A)in peripheral blood of each group were detected by enzyme-linked immunosorbent assay,and the results were statistically analyzed.Results The levels of IL-2、IFN-γ、IL-4、IL-17A in patients with neurosyphilis,serum fixation and the control group were statistically different(P<0.05).Peripheral blood IL-2,IFN-γ and IL-4 in patients with neurosyphilis and serum fixation were higher than those in the control group and IL-17A was lower than those in the control group,showing statistical differences(P<0.05).There was no significant difference between neurosyphilis and Th1,Th2 and Th17 cytokines in peripheral blood of patients with serum fixation(p>0.05).The levels of IL-2、IFN-γ、IL-4、IL-17A in patients with neurosyphilis at different clinical stages were statistically different from those in the control group(P<0.05).There was no significant difference in IL-17A between early neurosyphilis and the control group(P>0.05),and IL-17A in patients with advanced neurosyphilis was lower than that in the control group(P<0.05).Conclusion Patients with neurosyphilis and serum fixation have abnormal immune function.The immune status of patients at different stages is different.Th1,Th2 and Th17 cytokines are involved in the immune response of patients with neurosyphilis and serological fixation and there is an abnormal balance.更多还原