Study On Influence Factors Related To Therapeutic Effect Of Neurosyphilis And The Substitutability Of Cerebrospinal Fluid Reexamination After Treatment

Background:The morbidity of neurosyphilis has risen obviously in the past two decades.With the prevalence of HIV,the effectiveness of penicillin in the treatment of neurosyphilis has been questioned.International research on the neurosyphilis therapy have small sample capacity and different results.A Chinese analysis of the influence factors affecting the efficacy of neurosyphilis has dozens sample,but the criterion of effectiveness is based on the titer of serum RPR but lack of cerebrospinal fluid reexamination.Objective:Review the inpatient cases to analyze the influence factors related to the efficacy of neurosyphilis.And the synchronization of symptoms,serum RPR titer and cerebrospinal fluid changes were analyzed to explore the substitutability of the cerebrospinal fluid reexamination after the treatment of the neurosyphilis.Methods:The data of hospitalized patients with neurosyphilis in Nanjing second hospital from March 2008 to June 2017,and in the dermatology department of the second hospital district of Jiangsu province hospital from December 2013 to June 2017 were retrospectively analyzed.Record the sex,age,sexual partner infection history,course of syphilis,history of treatment,HIV history,alcoholism history,history of hypertension,diabetes history,heart disease history,treatment medicine,delivery frequency,serum syphilis antibody and cerebrospinal fluid results before and after treatment,mental symptom changes.Through chi square test,Pearson correlation analysis and logistic regression analysis to find the factors that may affect the therapeutic effect of neurosyphilis.Use the chi square test to analyze the synchronization of symptoms,serum RPR titer and cerebrospinal fluid changes,and explore the alternative index of the cerebrospinal fluid examination after the treatment of the neurosyphilis.Results:In total,80 of the 271 enrolled neurosyphilis patients with complete data were meet the criterion.Half a year after the treatment,53 of the 65 cases treated with penicillin were effective.And 11 of the 13 cases treated with ceftriaxone were effective.But 2 cases used doxycycline were ineffective.The chi square test of various factors related to the curative effect for half a year showed that patients with alcoholism or hypertension had poor cerebrospinal fluid effect.The efficacy of ceftriaxone and penicillin were same.Spearman correlation analysis showed:The curative effect of serum RPR after half a year was low intensity positively correlated with serum RPR titer before treatment.The effect of serum RPR after a year was moderate intensity positively correlated with the serum RPR titer before treatment.The curative effect of cerebrospinal fluid after half a year was low intensity negatively correlated with alcoholism and hypertension.After a year of treatment,CSF effect was low intensity negatively correlated with alcoholism.Logistic regression analysis of multiple factors related to the curative effect showed:HIV positive was negatively correlated with the efficacy of serum RPR after half a year,but the initial serum RPR titer was positively correlated.Alcoholism and hypertension were negatively correlated with the curative effect of cerebrospinal fluid after half a year.The initial serum RPR titer was positively correlated with the effect of serum RPR a year after treatment.Alcoholism is negatively correlated with CSF efficacy a year after treatment.The improvement of mental symptoms is more obvious than other symptoms,and it can help to predict the efficacy of neurosyphilis.With the increase of initial serum RPR titer before treatment,the consistency of RPR titer and neurosyphilis effect is increased.Patients with initial serum RPR titer>l:32 before treatment have a higher consistency between serum RPR effect and CSF effect.Conclusion:The effect of penicillin on neurosyphilis is reliable,ceftriaxone can be an effective alternative medicine.Alcoholism and hypertension may reduce the curative effect of neurosyphilis treatment.Patients with HIV have a slightly decrease in the effect.High serum RPR titer before treatment may lead more obvious effect of serum RPR.Serum RPR titer>1:32 or the patients with mental symptoms before treatment may choose the serum RPR titer or the mental symptoms changes as the substitutes of cerebrospinal fluid examination after treatment.