梅毒血清固定患者神经梅毒患病率的Meta分析

doi:10.19871/j.cnki.xfcrbzz.2022.04.015

摘要/Abstract

摘要： 目的采用Meta分析方法估计梅毒血清固定患者中神经梅毒的患病情况,并分析其影响因素。方法检索中国期刊全文数据库、万方数据知识服务平台和PubMed数据库,收集有明确的梅毒血清固定和神经梅毒定义,且有报道血清固定病例数及神经梅毒病例数的文献。运用R软件进行统计分析。结果共检索到文献769篇,最终纳入文献23篇,涉及梅毒血清固定患者2103例,其中神经梅毒患者420例。使用随机效应模型计算梅毒血清固定患者中神经梅毒患病率为18%（95%CI：13%~25%）。血清固定患者的年龄（χ²=104.82,P<0.001）和判断血清固定的随访时间（χ²=139.44,P<0.001）不同,神经梅毒患病率存在统计学差异。脑脊液检测方法不同,神经梅毒检测阳性率也存在统计学差异（χ²=137.86,P<0.001）。结论梅毒血清固定患者中神经梅毒患病率较高。应进一步加强梅毒血清固定与神经梅毒方面的研究,以期为制定梅毒防控政策提供科学依据。

关键词: 梅毒, 血清固定, 神经梅毒, Meta分析

Abstract: Objective To estimate the prevalence of neurosyphilis among syphilis serofast patients and analyze its associated factors using a meta-analysis approach. Method Key words with syphilis serofast and neurosyphilis were searched in the Chinese National Knowledge Infrastructure (CNKI), Wan Fang Database and PubMed. Literatures with clear definitions of syphilis serofast and neurosyphilis, and reporting the numbers of both serofast patients and neurosyphilis patients were collected. Statistical analysis was performed in the R software. Result A total of 769 literatures were retrieved, and 23 literatures were finally included. The included literatures involved 2103 syphilis serofast patients, among whom 420 were neurosyphilis patients. The prevalence of neurosyphilis among serofast patients was 18% (95% CI: 13% to 25%) in the random-effects model. The prevalence rates varied with serofast patients' age (χ²=104.82, P<0.001) and the follow-up time to define serofast (χ²=139.44, P<0.001). The positive rates of neurosyphilis testing also varied with detection methods of cerebrospinal fluid (χ²=137.86, P<0.001). Conclusion Syphilis serofast patients have high prevalence of neurosyphilis. It is necessary to conduct more researches on the relationships between syphilis serofast and neurosyphilis, and thus provide more scientific data for the formulation of syphilis prevention and control policies.

Key words: Syphilis, Serofast, Neurosyphilis, Meta-analysis

吴肖冰, 茅雅君, 刘鑫, 关杨, 郑锦芬. 梅毒血清固定患者神经梅毒患病率的Meta分析[J]. 新发传染病电子杂志, 2022, 7(4): 65-69.

Wu Xiaobing, Mao Yajun, Liu Xin, Guan Yang, Zheng Jinfen. Prevalence of neurosyphilis among syphilis serofast patients: a Meta-analysis[J]. Electronic Journal of Emerging Infectious Diseases, 2022, 7(4): 65-69.

参考文献

[1] 中国疾病预防控制中心, 中华医学会皮肤性病学分会性病学组, 中国医师协会皮肤科医师分会性病亚专业委员会. 梅毒、淋病和生殖道沙眼衣原体感染诊疗指南(2020年)[J]. 中华皮肤科杂志, 2020, 53(3):168-179.
[2] SENA AC, ZHANG XH, LI T, et al.A systematic review of syphilis serological treatment outcomes in HIV-infected and HIV-uninfected persons: rethinking the significance of serological non-responsiveness and the serofast state after therapy[J]. BMC Infect Dis, 2015, 15: 479
[3] 邹亚明, 刘凤英, 陈磊, 等. 广东省2005-2014 年梅毒流行趋势和疾病负担[J]. 中山大学学报(医学科学版), 2016, 37(1): 142-147.
[4] CAI SN, LONG J, CHEN C, et al.Incidence of asymptomatic neurosyphilis in serofast Chinese syphilis patients[J]. Sci Rep, 2017, 7(1): 15456.
[5] 李淑莲, 林志锋, 张惠珊, 等. 梅毒血清固定与神经梅毒的关系[J]. 中华医院感染学杂志, 2012, 22(10): 2235-2238.
[6] LONEY PL, CHAMBERS LW, BENNETT KJ, et al.Critical appraisal of the health research literature: prevalence or incidence of a health problem[J]. Chronic Dis Can, 1998, 19(4): 170-176.
[7] CECCARELLI G, BORRAZZO C, LAZZARO A, et al.Diagnostic Issues of Asymptomatic Neurosyphilis in HIV-Positive Patients: A Retrospective Study[J]. Brain Sci, 2019, 9(10): 278.
[8] PASTUSZCZAK M, SITKO M, BOCIAGA-JASIK M, et al.Lack of antiretroviral therapy is associated with higher risk of neurosyphilis among HIV-infected patients who remain serofast after therapy for early syphilis[J]. Medicine (Baltimore), 2018, 97(45):e13171.
[9] 张艳, 吴春丽, 瞿镔, 等. 260例治疗失败梅毒患者血、脑脊液白细胞介素-6、10及肿瘤坏死因子-α检测结果分析[J]. 浙江中西医结合杂志, 2016, 26(4): 341-344.
[10] 侯宏波, 邓丽宁. 梅毒血清固定患者126例临床及脑脊液检测分析[J]. 临床和实验医学杂志, 2016, 15(12): 1214-1216.
[11] 王娜, 蒋法兴, 朱文, 等. 非梅毒螺旋体血清学试验持续阳性梅毒患者神经梅毒发生情况及影响因素分析[J]. 中华皮肤科杂志, 2016, 49(5): 314-317.
[12] 何彩凤, 常小丽, 王军, 等. 大剂量水剂青霉素联合匹多莫德片治疗HIV阴性的血清固定梅毒[J]. 皖南医学院学报, 2016, 35(3): 255-258.
[13] 黄艳丽. 76例梅毒血清固定患者的系统损害分析[J]. 医药前沿, 2016, 6(3): 126-127.
[14] 赵郑滟. 130例住院梅毒患者血清固定的相关因素分析[D]. 浙江: 浙江大学, 2014.
[15] 钟永军, 李德宪, 苏腾良, 等. 385例早期梅毒患者血清固定及其影响因素[J]. 中国麻风皮肤病杂志, 2013, 29(11): 706-708.
[16] ZHOU P, GU X, LU H, et al.Re-evaluation of serological criteria for early syphilis treatment efficacy: progression to neurosyphilis despite therapy[J]. Sex Transm Infect, 2012, 88(5): 342-345.
[17] 黄珊珊, 钟剑波, 李凌. 梅毒血清固定患者45例临床及脑脊液结果分析[J]. 浙江中西医结合杂志, 2012, 22(5): 380-381.
[18] 阮黎明, 刘晓艳, 蒋筱凌, 等. 梅毒血清固定患者66例临床分析[J]. 浙江医学, 2012, 34(10): 786-788.
[19] 彭文君, 查芹, 翁秋燕. 脑脊液细胞学在血清固定梅毒患者中的诊断价值[J]. 现代实用医学, 2012, 24(12): 1338-1340.
[20] 杨文林, 杨健, 许教雄, 等. 梅毒血清固定患者的系统受累状况[J]. 临床皮肤科杂志, 2012, 41(7): 406-408.
[21] 戴艳. 119例梅毒血清固定患者的临床分析及其外周血中髓系衍生抑制细胞(MDSC)的检测[D]. 湖北: 华中科技大学, 2011.
[22] 吴颖之. 梅毒血清固定的临床研究[D]. 上海: 复旦大学, 2010.
[23] 林路洋, 杨日东, 张锡宝, 等. 隐性梅毒患者神经梅毒患病率分析[J]. 国际皮肤性病学杂志, 2010, 36(6): 303-305.
[24] 黄钟. 20例梅毒血清固定患者的临床分析[D]. 福建: 福建医科大学, 2010.
[25] 黄辉云. 梅毒血清固定患者脑脊液情况及外周血T淋巴细胞亚群的表达[D]. 湖南: 中南大学, 2009.
[26] 杨文林, 杨健, 黄新宇, 等. 梅毒血清固定病人的脑脊液及免疫功能检测[J]. 中国医师杂志, 2005, 7(5): 644-646.
[27] 杨日东, 李季, 梁艳华, 等. 梅毒患者脑脊液检测的意义[J]. 中国麻风皮肤病杂志, 2004,20(3): 229-231.
[28] ZETOLA NM, ENGELMAN J, JENSEN TP, et al.Syphilis in the united states: an update for clinicians with an emphasis on HIV coinfection[J]. Mayo Clin Proc, 2007, 82(9): 1091-1102.
[29] 郑锦芬, 王千秋, 赖永珲, 等. 100例梅毒血清固定患者临床分析[J/CD]. 新发传染病电子杂志, 2022, 7(2):67-70.
[30] SHI M, PENG RR, GAO Z, et al.Risk profiles of neurosyphilis in HIV-negative patients with primary, secondary and latent syphilis: implications for clinical intervention[J]. J Eur Acad Dermatol Venereol, 2016, 30(4): 659-666.
[31] SENA AC, WOLFF M, MARTIN DH, et al.Predictors of serological cure and Serofast State after treatment in HIV-negative persons with early syphilis[J]. Clin Infect Dis, 2011, 53(11): 1092-1099.
[32] TONG ML, LIN LR, LIN GL, et al.Factors associated with serological cure and the serofast state of HIV-negative patients with primary, secondary, latent, and tertiary syphilis[J]. PLoS One, 2013, 8(7): e70102.
[33] 黄进梅, 曾维英, 薛耀华, 等. 脑脊液VDRL、TRUST、IgM抗体检测对神经梅毒的诊断价值[J]. 皮肤性病诊疗学杂志, 2016, 23(4): 240-242.
[34] 中华人民共和国国家卫生和计划生育委员会,WS 273-2018. 梅毒诊断WS 273-2018. 梅毒诊断[S]. 2018.
[35] MARRA CM, MAXWELL CL, DUNAWAY SB, et al.Cerebrospinal fluid treponema pallidum particle agglutination assay for neurosyphilis diagnosis[J]. J Clin Microbiol, 2017, 55(6): 1865-1870.
[36] TAN X, ZHANG J, LI J, et al.The prevalence of asymptomatic neurosyphilis among HIV-negative serofast patients in China: a meta-analysis[J]. PLoS One, 2020, 15(11): e0241572.