| Objective:Syphilis is a kind of chronic multi-system sexually transmitted disease,which can cause irreversible damage to various tissues and organs of the body.It ranks the first among sexually transmitted diseases in China.Under normal circumstances,the clinical manifestations of syphilis patients disappear after routine antiplums treatment,and the serum test of non-treponema pallidum can turn negative within 3～6 months.Long-term clinical observation showed that although some patients’ clinical symptoms disappeared after treatment,their RPR titers and USR remained unchanged in a certain range for a long time,which was manifested as Serofast.The mechanism of serum fixation in syphilis is unknown,but it is thought to be related to immune imbalance.In this study,by analyzing the expression of IL-2 and IL-4 in serum of patients with serum fixation after early syphilis treatment,new patients with untreated early syphilis and patients with RPR titer turning negative after early syphilis treatment,the cause of continuous positive RPR titer in rapid plasma response test was preliminarily discussed.Further analysis of the immune mechanism of Th1/Th2 cells in the early stage of syphilis serologic fixation provides a new idea and method for the diagnosis and treatment of early stage syphilis serologic fixation.Methods: A total of 90 patients with early syphilis treated in the First Affiliated Hospital of Hebei North University between October 2017 and October 2022 were selected as the Study subjects,and 30 healthy volunteers in the same time range were selected as the normal control group.Among them,30 patients with early syphilis with serological fixation were included in the fixed group,30 untreated patients with newly diagnosed early syphilis were included in the syphilis group,and 30 patients with early syphilis who turned negative after regular treatment were included in the negative group.Flow cytometry was used to determine the expression levels of interleukin-2 and interleukin-4 in each group.SPSS 23.0 software was used for data processing and statistical analysis.Results:1.Comparison of basic data showed that there was no statistical significance in age and gender among the four groups(P > 0.05).There was no significant difference in stage and baseline RPR between the syphilis group,negative conversion group and fixed group(P > 0.05).2.Results of comparison of serum IL-2 expression levels among four groups:fixation group<syphilis group<negative conversion group<health group,there was a significant difference between the fixed group and syphilis group and negative group(P<0.05),while there was no significant difference between the negative group and healthy group,with no statistical significance(P>0.05).3.Results of comparison of serum IL-4 expression levels among four groups: fixation group>syphilis group>negative conversion group>health group,the difference was statistically significant(P <0.05).4.Analysis of the relationship between serum IL-2 and IL-4 in patients with early syphilis serofixation using Spearman correlation coefficient showed a highly significant negative correlation between the two(r =-0.575,P = 0.001).5.Spearman correlation coefficient was used to analyze the relationship between RPR titer and IL-2 and IL-4 in peripheral blood.It was found that the level of RPR titer in patients with early syphilis serofixation was correlated with the change of cytokine values,in which IL-2 was negatively correlated with RPR titer(r =-0.573,P = 0.001),and IL-4 was positively correlated with RPR titer(r = 0.094,P < 0.001).Conclusion:Compared with patients with newly diagnosed early syphilis and patients with early syphilis who turned negative after treatment,the expression level of IL-2 in patients with early syphilis serofixation is decreased,while the expression level of IL-4 is significantly increased,suggesting that the balance of Th1/Th2 in patients with early syphilis serofixation is significantly shifted to Th2 direction,Th2 cells are dominant,and humoral immunity is dominant.This may be a potential factor for the change of RPR titer.It also suggests that Th1/Th2 imbalance plays an important role in the pathogenesis of serum fixation in early syphilis. |
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