Objective To review the clinical characteristics, causes and treatment of serum-resistance in patients with syphilis. Methods Clinical data of 66 patients with syphilis serum-resistance were retrospectively analyzed. Subgroups of periphery T lymphocytes were examined by flow cytometry in 32 patients with syphilis serum-resistance and 30 healthy controls. Results Among 66 patients with syphilis serum-resistance, 19 were males and 47 females with the M/F ratio of 1: 2.4. There were 4 cases with primary syphilis (6.1%), 9 cases with secondary syphilis (13.6%) and 53 cases with latent syphilis (80.3%). The RPR titer ranged from 1:1 to 1:32, Among the 66 patients, one was diagnosed as ocular syphilis (secondary syphilis), and 4 as asymptomatic neurosyphilis with positive RPR and TPPA tests in cerebrospinal fluid. In the initial treatment,alternative treatment including oral erythromycin, tetracycline and azithromycin were applied in 9 cases (13.6%), and irregular treatment was applied in 6 cases (9.1%). There were no significant differences in periphery CD3+ and CD4+T lymphocytes between patients with syphilis serum-resistance and healthy controls (P >0.05); periphery CD8+ T lymphocytes increased significantly (P<0.05), while NK cells and the ratio of CD4+/CD8+ T lymphocytes decreased significantly (P<0.05)in patients with syphilis serum-resistance. Conclusion Irregular or alternative treatment at early stage for asymptomatic neurosyphilis and latent focal infection might be the key factors leading to syphilis serum-resistance, which may be closely associated with disorder of cellular immunity and immunosuppression.%目的 探讨梅毒血清固定的临床特点、产生原因和相应对策.方法 选取66 例梅毒血清固定患者,分析其临床资料,同时应用流式细胞仪对其中32 例患者(观察组)及同期30例正常对照者(对照组)外周血T 细胞亚群及NK 细胞进行检测.结果 66 例中Ⅰ期梅毒发生血清固定4 例(6%),Ⅱ期梅毒发生血清固定9例(13.6%),潜伏梅毒发生血清固定53 例(80.32%).血清固定RPR 阳性滴度为1∶1～1∶32.其中1 例确诊为Ⅱ期眼梅毒,4 例脑脊液同时有RPR、TPHA阳性,确诊为无症状神经梅毒.梅毒确诊后初治:9 例(13.6%)选用口服红霉素、四环素或阿奇霉素替代疗法,6例(9%)存在不规则用药情况.与对照组比较,观察组外周血T细胞亚群CD3+、CD4+细胞无明显变化(P ＞0.05),CD8+细胞显著升高(P＜0.01),NK 细胞及CD4+/CD8+明显降低(P＜0.01).结论 梅毒感染早期未及时规范治疗、用药不规范或以替代药物治疗、无症状神经梅毒和潜在感染灶存在可能是导致梅毒血清固定的重要原因.梅毒血清固定患者细胞免疫功能紊乱,免疫抑制与梅毒血清固定的发生密切相关.
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