Clinical Comparison And Analysis Of Cerebrospinal Fluid Detection Before And After Ceftriaxone Sodium And Penicillin Treatment Of Early Neurosyphilis

Objective To explore the clinical comparison and analysis of cerebrospinal fluid(CSF) detection before and after treatments with ceftriaxone sodium and penicillin of early neurosyphilis. And provide clinical theory for early diagnosis, therapy and follow-up of neurosyphilis, so as to prevent neurosyphilis development from early syphilis.Methods Total 32 patients of neurosyphilis from January 2008 to December 2013 were randomly divided into ceftriaxone sodium group(17 cases) administrated with intravenous dripping of ceftriaxone sodium(2.0g/d, 10 to 14days) and aqueous penicillin group(15 cases) administrated with penicillin(4 million unit, 1 time/4h, 10 to 14days) followed by intramuscular injection of benzylpenicillin G(2.4 million unit, 1 time/week, total 3 times). Respectively after the treatment for 6, 12, and 18 months of serum and CSF follow-up examination and observation were compared between the two groups before and after treatment and positive titers of RPR in serum and CSF, CSF leukocyte count(WBC), quantitative changes in CSF protein and the adverse reaction incidence. SPSS17.0 was adopted for data statistical management.Results After treatments for 6 months, ceftriaxone sodium group and penicillin group serum RPR titers decreased in varying degrees were 16 cases(94.1%), 14 cases(93.3%), of which there were 7 cases(41.2%), 7 cases(46.7%) separately decreased 4 times and more,the disparity had no statistical significance(χ~2=0.098,P=0.755). CSF RPR titers were 9 cases(52.9%), 8 cases(53.3%) decreased, the difference of two groups had no statistical significance(χ~2=0.000, P=0.982). And there were 11 cases(64.7%), 10 cases(66.7%) separately of WBC count decreased below 10×106/L, the difference of two groups had no statistical significance(χ~2=0.014,P=0.907). The RPR titers changes in serum and CSF of two groups had no statistical significance(separately Z=-1.106,P=0.269; Z=- 1.140, P=0.254). And 12 months after treatment, two groups 14 cases(82.3%), 13 cases(86.7%) in serum and CSF RPR were negative; and 15 cases(88.2%), 14 cases(93.3%) separately of WBC count declined below 10×106/L; meanwhile 13 cases(76.5%) CSF RPR were negative and 13 cases(86.7%)of WBC count declined below 10×106/L. All the differences above had no statistical significance(separately χ~2=0.112, P=0.737; χ~2=0.244, P=0.621; χ~2=0.544, P=0.461). Separately 6 cases(35.3%), 5 cases(33.3%) of CSF protein declined below 500 mg/L, the differences had no statistical significance(χ~2=0.014,P=0.907). And 18 months after treatment, two groups 16 cases(94.1%), 14 cases(93.3%) serum and CSF RPR were negative; and meanwhile 11 cases(64.7%)CSF RPR were negative, 12 cases(80.0%)of WBC count decreased below 5×106/L. The differences of two groups had no statistical significance(separately χ~2=0.008,P=0.927; χ~2=0.922,P=0.337). At the same time, there were 12 cases(70.6%), 12 cases(80.0%) satisfied with serum and CSF RPR negative, CSF WBC count decreased below 10×106/L and CSF protein declined below 500 mg/L, the difference of two groups had no statistical significance(χ~2=0.153,P=0.696). But CSF WBC count of penicillin group was lower than ceftriaxone sodium group, the difference had statistical significance(t =1.428,P=0.001). And one case of serum and CSF RPR was not negative separately and missed follow-up. No Jarisch-Herxheimer response occurred during the treatments of all patients.Conclusion The disparities of serum and CSF RPR titers, CSF WBC count, CSF protein have no obviously statistical significance after the treatments with ceftriaxone sodium and penicillin; serum RPR titer changes can replace CSF RPR in neurosyphilis follow-up as an effective index, CSF WBC is sensitive to evaluate clinical the treatment, but the mechanism of action of CSF protein during the neurosyphilis need further more investigation. Risk awareness of early syphilis developing into neurosyphilis should be strengthened in our clinical work. And CSF examination in time can reduce the risk, early diagnosis and suitable intervention play an important role in preventing neurosyphilis development.