Clinical Analysis Of 119 Syphilitic Sero-resistant Patients And Detection Myeloid Derived Suppressor Cells In Peripheral Blood Of Them

Objective:To investigate the reasons of syphilitic sero-resistance phenomenon and its relevant factors by analysis clinical characteristics of syphilitic sero-resistant patients.To explore the role of myeloid derived suppressor cells (MDSC) in cellular immunity of syphilitic sero-resistant patients by means of detection it in peripheral blood of them. The ultimate aim is provide basis for effective preventive and treatment measures of syphilitic sero-resistant patients.Methods:1. The complete clinical data of 119 syphilitic sero-resistant patients who treated in dermatology department of our hospital were reviewed from January 2000 to December 2010.2. Flow cytometry was used to detect CD11b+CD33+ HLA-DR- MDSC in peripheral blood of syphilitic sero-resistant patients,and analysis the relationship between the level of MDSC and sero-resistance RPR titer.Results:1. Epidemiological features:syphilitic sero-resistance mainly occurs in sexually active young adults, male to female ratio is about 1:2.5, freelance workers,workers and individual businesses accounted for 68.07%, the cultural level of high school and junior high school accounted for 64.7%, 49.58% of them concurrently infect other sexually transmitted diseases.2. Syphilis type and initial RPR titer:25(21.01%)symptomatic syphilis cases, 94 (78.99%)latent syphilis cases. Initial RPR titer: 19(15.97%)cases of 1:64;41(34.45%)cases of 1:32;28(23.53%)cases of 1:16;18(15.13%)cases of 1:8;8(6.72%)cases of 1:4;5(4.20%)cases of 1:2.3. Formation time of sero-resistance:formation time of symptomatic syphilis sero-resistance : 17(68.00%)cases in six months;4(16.00%)cases in six months to one year;4(16.00%)cases more than one year. Formation time of latent syphilis sero-resistance: 46(48.94%)cases in six months;26(27.66%)cases in six months to one year;22(23.40%)cases more than one year. No significant differences between them(P>0.05).4. Cerebrospinal fluid(CSF) detection:24 patients detected CSF, 14 cases TPPA(-)RPR(-);10 cases of TPPA(+)RPR(-). 1 case albumin contents increased, 2 cases lactate dehydrogenase increased, CSF colour,pressure and white blood cell counts were normal.24 patients didn't display neurological symptoms and signs .5. Pregnant women with syphilitic sero-resistance:After regular anti-syphilitic treatment of large dose aqueous penicillin, the RPR titer of 23 patients didn't increase, syphilid didn't happen, and side effects weren't shown during the whole treatment. Pregnant outcomes:term delivery 95.65%(22/23), premature birth 4.35%(1/23); birth weight all in the normal range,physical growth were normal;3(13.04%)cases of TPPA(+) RPR(+),19 (82.61%) cases of TPPA(+) RPR(-),1(4.35%)case of TPPA(-) RPR(-),didn't have early congenital dominant syphilis infant. Follow-up visit:RPR of 23 infants all turned negative after 6 months of birth, TPPA all turned negative after 9 months of birth;follow-up 2～3 years, physical growth and mental development were normal .6. T lymphocyte subsets detection:60 patients were examined T lymphocyte subsets, 32(53.33%)cases were normal , 28(46.67%)cases were abnormal, 26 cases (43.33%) CD4 +T cells decreased ,21 (35.00%) cases CD8+ T cells increased, 23 (38.33%) cases CD4 +/CD8 +ratio decreased.7. MDSC detection:The proportion of MDSC in peripheral blood of syphilitic sero-resistant patients and health control group,respectively ,13.00%±9.22%,6.20%±3.41% ,showed statistically significant differences (P<0.05).Conclusions:1. The incidence rate of sero-resistance was higher in latent syphilis than in symptomatic syphilis.2. Syphilitic sero-resistance may be relevant to asymptomatic neurosyphilis.3. Large dose of aqueous penicillin is an effective and safety treatment for pregnant women with syphilitic sero-resistance, can control incidence of congenital syphilis infant and improve pregnancy outcomes.4. CD4 +/CD8 + ratio reduction may be associated with the incidence of syphilitic sero-resistance.5. The increase of MDSC in peripheral blood of syphilitic sero-resistant patients, may be play an impotant role in cellular immunity suppression of them.