| ObjectiveTo investigate the clinical features and the influence factors of serofast reaction in patients with syphilis.MethodsClinical data of130serofast syphilis patients in our hospital between June2011and October2013were retrospectively analyzed, including gender, age, starting performance, disease stage, basic diseases, with other infections, previous anti-syphilis treatment, serofast reaction formation time, laboratory tests (syphilis serology RPR and TPPA, cerebrospinal fluid examination, urine routine, biochemical and series of antinuclear antibodies, tumor markers, CRP, ESR, ASO, RF, T cell subgroups, immunoglobulin and complement) and imaging examination.Results1. In130cases of serofast syphilis, male:female ratio was1:2.9, and the average age was33.86±13.02years old. Female (31.43±11.71years) was younger than male (41.00±14.22years)(P<0.01).7(5.4%) patients were diagnosed as primary syphilis,29(22.3%) patients as secondary syphilis,94(72.3%) patients as latent syphilis. Courses were from6months to17years (29.22±30.64months).In130patients,22(16.9%) patients accompanied with other diseases,14(10.8%) with other infections,9(6.9%) with a history of surgery,3(2.3%) with a history of blood transfusion. Initial serum RPR titers were from1:1to1:512, including114patients (87.7%) in1:32or <1:32, and16patients (12.3%)in>1:32. Fixed titers were from1:1to1:16, including117patients (90.0%) in1:8or<1:8, and13patients (10.0%) in>1:8. All patients had been treated by recommended standard anti-syphilis treatment.2. Cerebrospinal fluid (CSF) was tested in86patients. CSF routine was normal in20(23.3%) patients. Results of CSF-TPPA tests were positive in25(29.1%) patients.4patients (4.7%) had both CSF-TPPA positive and CSF routine abnormality. In All primary syphilis patients were CSF-TPPA(-).8secondary syphilis patients (32.0%) were CSF-TPPA(+).17latent syphilis patients(68.0%) were CSF-TPPA(+). Average age of CSF-TPPA(+)(41.56±14.07years) was significantly higher than that of CSF-TPPA (-) group (32.34±8.79years)(P<0.01).3. CD3and CD8count of patients with serofast syphilis (73.55±9.42,28.07±7.99) were higher than that of healthy controls (67.46±9.65,24.70±6.81)(P<0.01, P<0.05), NK cell count (13.52±9.37) was significantly lower than healthy controls (18.41±6.15)(P<.01). CD3and CD8of the female (75.38±8.15,29.47±8.19) were higher than those of male (68.10±10.90,23.93±5.75)(P<0.01). NK cell count (12.30±8.26) was significantly lower than those of male (17.16±11.49)(P<0.05). CD3in Patients with initial serum RPR<1:8or=1:8(75.27±7.97) was higher than that of initial serum RPR>1:8(71.53±10.62)(P<0.05). NK cell in Patients with CSF-TPPA(+)(12.90±9.35) was significantly lower than that of CSF-TPPA(-) patients (15.94±11.10)(P<0.01). IgA level of serofast syphilis (224.63±100.83) was significantly higher than that of the control group (100.48±44.13)(P<0.01), C4(19.40±5.97) was lower than control group (22.16±5.69)(P<0.05).4. Blood routine and biochemistry tests were done in all patients. WBC count was raised in3.1%(4/130) and reduced in7.7%(10/130). Neutrophils were raised in7.7%(10/130) and reduced in19.2%(25/130). Lymphocytes were raised in20.0%(26/130) and reduced in9.2%(12/130). Hemoglobin was reduced in6.2%(8/130). Total protein was reduced in18.5%(24/130). Globulin was reduced in13.8%(18/130). CRP was raised in2.8%(2/72). ESR was raised3.4%(2/58). ASO was raised in24.2%(15/62). RF was raised in6.5%(4/62). Ferritin was raised in2.5%(2/79) and reduced in3.8%(3/79). CA199was raised in2.5%(2/79). Antinuclear antibody tests were positive inl1.4%(7/67).5. Ultrasound was examined in119patients. The results were cardiovascular abnormal in74(62.2%) patients, mainly for mitral regurgitation, tricuspid regurgitation and left ventricular diastolic function impairment. Magnetic resonance image was examined in41patients. The results were craniocerebral abnormal in16(39.0%) patients.Conclusion 1. In patients with serofast syphilis were more common in female than male. Female patients were younger than male and duration in female was longer than that in male. Strengthening the screening of latent syphilis and timely and effective treatment was the key to reduce the form of syphilis serofast reaction.2. The proportion of syphilis was highest in latent syphilis (72.3%), followed by secondary syphilis (22.3%) and primary syphilis (5.4%).3. The immune functions of serofast syphilis patients were abnormal. The result of CD3and CD8cell counts were raised in patients. The results of NK cell were reduced in patients.4. Incidence of neurosyphilis was29.1%.patients with CSF-TPPA (+), who rarely had symptoms of nervous system. Syphilis patients with serofast reaction were necessary to take routine and syphilis examination of CSF, especially for latent syphilis patients with asymptomatic, in order to make a diagnosis and effective treatment as early as possible. |
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