| Objective:To explore the factors for serological cure of syphilis by analysising related clinical data of patients with serum reaction maintaining positive last for 2 years after regular treatment.To summarize general variation regularities of syphilis course,and provide reference for prevention and treatment of syphilis.Methods:Collected the clinical data of 85 syphilis inpatients with positive serum over 2 years after regular treatment from January 2014 to December 2016 in our hospital.According to the follow-up serum TRUST if>1:8,divided the inpatients into high titer group(n=9)and low titer group(n=76).As a comparison,collected the clinical data of 52 syphilis outpatients with serum negative conversion within 2 years after regular treatmen at the same time.Compared the difference this patients in age,sex distribution,disease duration,previous treatment,imaging data,serology and CSF results.Results:1 Clinical data:? Gender:There were 19 males(36.54%)and 33 females(63.46%)in negative conversion group,34 males(38.82%)and 51 females(61.18%)in seropositive group.The seropositive group ratio of male to female was slightly higher than that of negative group.(?2=0.163,P>0.05).There were 30 male(39.47%),46 females(60.53%)in the low titer group,4 males(44.44%)and 5 females(55.56%)in the high titer group but there was no significant difference between the two groups(?2=0.000P>0.05).? Age:The average age of seronegative group was(41.17± 16.02)years old and the average age of seropositive group was(39.29.48±14.55)years old.there was no statistically significance(t=0.689,P>0.05).The mean age of the low titer group was(38.39±14.00)years old,the average age of high titer group was(40.10±12.95)years old,the difference was not statistically significant.(t=1.674,P>0.05).?Initial serum TRUST:There were 32 cases(61.54%)of TRUST?1:8 and 20 cases(38.46%)of TRUST>1:8 in seronegative group,and 44 cases(58.76%)of TRUST?1:8 and 41 cases(48.24%)of TRUST>1:8 in seropositive group,the difference was not statistical significant(?2=1.248,P>0.05).There were 2 cases(22.22%)of TRUST?1:8 and 7 cases(77.78%)of TRUST>1:8 in the high titer group,the difference was not statisticalyl significant(?2=2.320,P>0.05).? Initial treatment:There were 51 cases(98.08%)received penicillin treatment and 1 case(1.92%)recevied non-penicillin treatment in seronegative group.In seropositive group,79 cases(92.94%)received penicillin treatment and 6 cases(7.06%)were treated with non-penicillin.There was no statistical significance between the two groups(?2=0.856,P>0.05).In low titer group,55 cases were treated with penicillin,7 cases with non-penicillin.26 cases got penicillin treatment and 4 cases were treated with non-penicillin in the high titer group.The difference between the two groups was not statistical significance(Fisher accurate inspection,P>0.05).?Latent syphilis:There were 27 cases(51.92%)of laten syphilis and 25 cases(48.08%)of dominant syphilis in seronegative group.63 cases(74.12%)of laten syphilis and 22(25.88%)of dominant syphilis in seropositive group.The difference was statistically significant(?2=7.052,P<0.01).In the low titer group,there were 60 cases(78.95%)of latent syphilis and 16 cases(21.05%)of dominant syphilis.There were 3 cases(33.33%)of latent syphilis and 6 cases(66.67%)of dominant syphilis in high titer group.There was no statistical significance(correction ?2=6.512,P<0.05).? Neurosyphilis ratio:There were 6 cases(9.84%)of neurosyphilis and 55 cases(90.16%)of non-neurosyphilis in low group.There were 3 cases(33.33%)of neurosyphilis and 6 cases(66.67%)of non-neurosyphilis in high titer group.There was no significant difference between the two groups(correction ?2=2.052,P>0.05).2 Cerebrospinal Fluid Examination:(?WBC:There were 6 cases(9.84%)with abnormal WBC and 55 cases(90.16%)with normal WBC in low titer group.In high titer group,there were 1 cases(11.11%)with abnormal WBC and 8 cases(88.89%)with normal WBC.The difference between the two groups was not statistically significant(?2=0.000,P>0.05).?Protein:There were 17 cases(9.84%)with abnormal protein and 44 cases(72.13%)with normal protein in low titer group.In high titer group,there were 3 cases(33.33%)with abnormal protein and 6 cases(66.67%)with normal protein.The difference between the two groups was not statistically significant(?2= 0.000,P>0.05).?Glucose:There were 2 cases(3.28%)with abnormal glucose and 59 cases(96.72%)with normal glucose in low titer group.In high titer group,there was no case with abnormal glucose and 9 cases(100.00%)with normal glucose.The difference between the two groups was not statistically significant(Fisher accurate inspection,?2=0.184,P>0.05).?ADA:There were 29 cases(47.54%)with abnormal ADA,and 32 cases(52.46%)with normal ADA.In high titer group,there were 5 cases(55.56%)wuth abnormal ADA and 4 cases(44.44%)with normal ADA.There was no significant difference between the two groups(correction ?2=0.008,P>0.05).? Pandy experiment:There were 14 cases(22.95%)with Pandy-positive and 47 cases(77.05%)with Pandy-negative in low titer group.In high titer group,there were 3 cases(33.33%)with Pandy-positive and 6 cases(66.67%)with Pandy-negative.The difference was not significant(correction ?2=0.0685,P>0.05).?TRUST:In the low titer group,there were 3 cases(4.92%)with positive TRUST and 58 cases(95.08%)with negative TRUST.There were 4 cases(44.44%)with TRUST positive and 5 cases(55.56%)with negative TRUST in the high titer group.There was significant difference between the two groups(?2=9.577,P<0.01).?TPPA:There were 21 cases(34.43%)with positive TPPA and 40 cases(65.57%)with negative TPPA in low titer group.In high titer group,there were 9 cases(10.00%)with positive TPPA and no case with negative TPPA.The positive TPPA rate in low titer group was significantly lower than what in high sero group(Fisher accurate inspection,P<0.01).?Double positive:In the low titer group,there were 3 cases(4.92%)with double positive TRUST and 58 cases(95.08%)with single positive.There were 4 cases(44.44%)with double positive and 5 cases(55.56%)with single positive in the high titer group.There was significant difference between the two groups(?2=9.577,P<0.01).3 Imaging examination:? Cardiac Color Doppler Ultrasound:There were 52 cases in low titer group examined by cardiac color Doppler ultrasound,19 abnormal cases and 33 normal cases.There were 5 cases in high sero titer group examined by cardiac color Doppler ultrasound with 2 abnormal cases and 3 normal cases.The difference was not significant(correction ?2=0.000,P>0.05).?MRI:In the low titer group,there were 52 patients were examined by head MRI,22 cases(42.31%)with abnormal MRI and 30 cases(57.69%)with normal MRI.In high sero titer group,there were 6 patients were examined by head MRI,3 cases(50.00%)with abnormal MRI and 3 cases(50.00%)with normal MRI.There were no significant differences between the two groups(correction?2=0.920,P>0.05).Conclusion:1 The relevant factors that impact syphilis serum negative conversion include latent syphilis at the first visit and neurosyphilis.2 The factors that have nothing to do with syphilis serum negative conversion include serum TRUST/RPR titer?1:8 at the first visit,drug selection,gender and age. |
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