神经梅毒的诊断与治疗（附23例分析）

观察神经梅毒的临床特点,以提高对神经梅毒的诊断与治疗水平。回顾性分析哈尔滨医科大学附属第一医院2005年1月至2010年12月收治的23例神经梅毒患者的临床资料。神经梅毒患者男17例（73.9%）,女6例（26.1%）,男女比约为2.8∶1;年龄27~71岁,平均年龄43.1岁。本组首发症状：麻痹性痴呆（7例）、精神异常（3例）、急性脑梗死（3例）、癫痫（2例）、脊髓病变（2例）、颅高压（2例）、周围神经损害（2例）、脑神经损害（1例）、无症状性神经梅毒（1例）。23例患者血清及脑脊液快速血浆反应素实验及梅毒螺旋体血凝试验均呈阳性反应。颅脑电子计算机断层扫描（CT）和/或磁共振成像（MRI）检查多表现为额叶、顶叶、颞叶、基底节等多发病变。本组患者经大剂量青霉素治疗后病情有显著改善20例,死亡1例,自动出院2例。神经梅毒的临床表现复杂多样,神经系统各部位均可受累,诊断依靠病史及临床表现、实验室血清及脑脊液梅毒抗体检测,误诊率高,应早期诊断,诊断后应进行规范治疗,早期治疗效果较好。     

ELISA法检测梅毒螺旋体抗体的评价

目前在国内医院、血站的实验室中梅毒血清学诊断主要应用非特异性试验 ,如快速血浆反应素环状卡片试验 (RPR)或甲苯胺红不加热血清试验(TRUST) ,特异性试验主要应用 TPPA或 TPHA。我们用国产 ELISA试剂 (双抗原夹心法 ) ,对梅毒患者与非梅毒患者的血清进行检测 ,并同时作TRUST与 TPPA检测 ,现将结果报告如下。1　材料与方法1 .1　对象　患者组 ,两院皮肤性病科确诊梅毒患者84例 ;非患者组 ,两院门诊、住院及健康查体者各随机抽取 1 5 0例 ,并排除梅毒螺旋体感染。1 .2　试剂　 ELISA试剂由广东中山生物工程有限公司提供 ;TP…     

化学发光微粒子免疫法和梅毒螺旋体颗粒凝集试验检测梅毒抗体的比较

目的评价化学发光微粒子免疫法（chemiluminescence microparticle immunoassay, CMIA）检测临床血清标本梅毒螺旋体抗体的敏感性和特异性。方法用梅毒螺旋体颗粒凝集试验（TVeponema Pallidum particie agglutination test,TPPA）法作为对照标准,采用CMIA法检测2012年11月到12月1200例住院患者的血清标本,并用卡方检验评价两种检测方法对同一个样本的化验结果的一致性。结果1200例血清标本中用CMIA法检出阳性率为11.3%,TPPA法检出阳性率为10. 9% ,以TPPA为标准,CMIA法敏感性为96. 9%,特异性为99. 2%,其中CMIA法检测血清S/CO值〉 4. 00的110例,用TPPA确认107例阳性,阳性预测值（PPV）为97.3%;CMIA法S/C0值在1.0-9.0,TPPA可出现阴性结果。结论CMIA法可替代TPPA法进行梅毒螺旋体抗体检测,对于CMIA法检测S/C0值1. 0-4.0的需进一步复检。     

梅毒住院患者63例血清学及脑脊液的临床分析

目的了解梅毒住院患者的流行病学、临床和血清学特征。方法对63例患者的临床资料及血清学、脑脊液等进行综合分析。结果87．30％（55例）患者血清TRUST呈低滴度表现（1：1～1：8）,14．29％（9例）为早期潜伏梅毒,15．87％（10例）为神经梅毒,52．38％（33例）为晚期潜伏梅毒,17．46％（11例）为无法判断病期的潜伏梅毒。73．02％（46例）传播途径为非婚性接触为主,性别分类中女性（49例）多于男性（14例）,低学历（54例）、待业者（18例）及性活跃期人群发病率高。结论潜伏（隐性）梅毒在梅毒分期中占有较大的比例;有必要对血清TRUST滴度持续（≥2年）不转阴患者进行神经梅毒的排查;有必要加强宣传性保护的重要性。     

早期先天梅毒几种实验室诊断方法的评价

目的评价梅毒螺旋体蛋白印迹试验(TPPA-IgM-WB)和梅毒螺旋体19(s)-IgM酶联免疫吸附法[TP-19(s)-IgM-ELISA]在先天梅毒早期诊断中的作用。方法对45例梅毒孕妇所产46例(1例双胞胎)新生儿运用血清IgM-WB试验、梅毒螺旋体19(s)-IgM酶联免疫吸附法[TP-19(s)-IgM-ELISA]和常规血清学方法(TPPA、RPR、FTA-ABS-IgM)检测,评价上述试验诊断方法在先天梅毒早期诊断中的作用。结果45例梅毒孕妇所生的新生儿中,按常规综合诊断方法21例确诊为先天梅毒,新生儿血清IgM蛋白印迹试验23例阳性,梅毒螺旋体19(s)-IgM酶联免疫吸附法24例阳性(21例常规方法诊断为先天梅毒)。30例作为对照的非梅毒孕妇及新生儿各项检查均为阴性。结论血清IgM蛋白印迹试验和梅毒螺旋体19(s)-IgM酶联免疫吸附法[TP-19(s)-IgM-ELISA]诊断先天梅毒具有较高的特异性和敏感性,结果显示可能高于现行的常规综合诊断方法的诊断价值。     

梅毒螺旋体重组抗原的表达及在梅毒血清学诊断中的应用

目的：克隆、表达梅毒螺旋体（Treponema pallidum, Tp）膜蛋白TpN47、TpN17、TpN44.5和TpN15,建立双抗原夹心ELISA法,探讨其在梅毒血清学诊断中的应用。方法：应用聚合酶链反应法（PCR）从Tp全基因组中扩增4个目的片段,克隆到载体pET-HT-JKM中,在BL21(DE3)plysS菌中诱导表达,Ni-NTA亲和层析法纯化重组蛋白,辣根过氧化物酶标记,双抗原夹心酶联免疫吸附法检测人血清中的特异性IgM和IgG抗体。结果：成功表达了4种重组蛋白用作ELISA包被和酶标抗原检测国家Tp参比血清,特异性和灵敏度均为100％;检测385份临床血清样本,结果与TPPA法相比符合率达到99％（P＜0.01）,灵敏度和特异性分别为98.2%（162/165）和99.5%（219/220）。结论：表达的4种重组抗原具有很好的生物活性,为理想的梅毒的血清学诊断用抗原。以这4种表达蛋白为基础建立的双抗原夹心ELISA法灵敏度高,特异性好,而且方法简单,结果客观,易于自动化操作,值得临床大力推广。     

15881例患者梅毒血清学诊断的方法学比较

目的了解本区域特殊群体梅毒检测的方法学意义。方法对2010—2013年在大连市皮肤病医院进行梅毒血清学检测的15881例患者和其中确证梅毒患者6488例资料进行回顾性分析,同时评价TRUST、TP—ELISA、TPPA和乳胶层析法检测特殊群体患者血清的意义。结果2010—2013年梅毒血清学阳性患者分别为1347例、1679例、1787例、1675例,共6488例,占大连市沙河口区梅毒确诊患者的82．13％、82．02％、75．18％、71．67％。TRUST、TP-ELISA、TPPA和乳胶层析法敏感性分别为74．48％、99．75％、99．46％、86．24％,特异性分别为99．65％、99．98％、99．95％、99．92％。结论梅毒患者和全国一样,有死灰复燃的趋势,且有从高危人群向普通人群蔓延的趋势;在大样本梅毒血清学试验中,TRUST和TP—ELISA结合法具有高度敏感性和特异性,可作为高危人群体检的方法首选。     

检测梅毒螺旋体抗体的纤维膜条方法的建立及其在诊断中的应用

目的：建立以纤维膜为载体的检测梅毒螺旋体抗体的方法,检查病人血清中对梅毒螺旋体多种抗原的抗体,用于梅毒感染的诊断。方法：将基因工程表达及纯化的梅毒螺旋体蛋白tp15、tp17、tp42和tp47分别结合在纤维膜上,用载抗原的纤维膜条检查血清中的抗体,抗体阳性者在相应抗原位置显示出特异条带。结果：梅毒螺旋体感染者血清中存在特异性抗体,在检查的460份临床诊断的患者血清中,对tp15、tp17、tp42和tp47抗原的抗体检出率分别为41.3%、100%、98.7%和51.7%;134份献血员血清抗体阴性。结论：建立的检测梅毒螺旋体感染的方法可同时检查对多种抗原的抗体,以纤维膜条作为诊断条检测血清抗体方法简便,用于临床诊断更特异、更敏感。     

西门子ADVIA Centaur XP化学发光免疫分析仪检测梅毒螺旋体特异性抗体的测量阈值建立及结果比较

本研究旨在探讨西门子ADVIA Centaur XP梅毒血清学试验化学发光免疫分析法(CLIA)检测梅毒螺旋体特异性抗体的测量阈值,并与化学发光微粒子免疫分析法(CMIA)、梅毒螺旋体免疫印迹法(TP-WB)及梅毒螺旋体抗体颗粒凝集试验(TPPA)法检测结果进行比较,为CLIA方法的规范应用提供参考。收集河北燕达医院2018年7月至2019年7月雅培ARCHITECTi2000CMIA法检测梅毒螺旋体特异性抗体筛查样本30887例,选取CMIA法筛查梅毒特异性抗体中样品吸光度与临界值的比值(S/CO)为1–9的153例患者为研究对象,采用梅毒血清学检测逆序流程,并分别以TP-WB及TPPA法为确认方法,运用Med Calc对结果进行受试者工作特征曲线(ROC曲线)分析,获得截断值,采用卡方检验进行计数资料的差异显著性检验。采用不同方法对同一批血清样本梅毒螺旋体特异性抗体的检测结果存在差异,CLIA法与TPPA法差异不显著,与TP-WB法及CMIA法差异显著;分别以TPPA检测结果和TP-WB检测结果为金标准,ROC曲线分析发现,CLIA法的最佳诊断截断值分别为4.01和16.06,曲线...     

Immuno-PCR法诊断早期梅毒的方法学建立及其应用

目的建立Immuno-PCR法诊断早期梅毒的方法学,评价其灵敏度、特异性、重复性及其临床应用。方法利用基因重组TpN47抗原免疫新西兰兔,制备抗体并用Weston blotting检测;利用抗TpN47抗体作为捕获抗体与血清中TpN47抗原结合,通过链霉亲和素、生物素化抗体、生物素化DNA和PCR扩增等建立Immuno-PCR法检测梅毒螺旋体抗原TpN47体系;评价该方法的灵敏度、特异性和重复性;收集200例临床标本通过Immuno-PCR法、ELISA、TPPA和TURST法进行临床应用比较。结果 Weston blotting结果显示TpN47抗体阳性;Immuno-PCR比ELISA法敏感性强103倍,比TPPA、TURST强105倍;特异性高,重复性好。临床标本中Immuno-PCR法敏感性和特异性分别为86.00%（P〈0.05）和100.00%,ELISA法为71.00%和98.00%,TPPA法为65.00%和100.00%,TRUST法为68.00%和95.00%。结论 Immuno-PCR法检测梅毒螺旋体TpN47抗原敏感性高,特异性强,重复性好,可作为梅毒螺旋体感染的早期诊断方法 。     

Cerebrospinal fluid tau, A beta, and phosphorylated tau protein for the diagnosis of Alzheimer's disease

The diagnosis of AD is still largely based on exclusion criteria of secondary causes and other forms of dementia with similar clinical pictures, than the diagnostic accuracy of AD is low. Improved methods of early diagnosis are needed, particularly because drugs treatment is more effective in the early stages of the disease. Recent research focused the attention to biochemical diagnostic markers (biomarkers) and according to the proposal of a consensus group on biomarkers, three candidate CSF markers reflecting the pathological AD processes, have recently been identified: total tau protein (t-tau), amyloid beta(1-42) protein (A beta42), and tau protein phosphorylated at AD-specific epitopes (p-tau). Several articles report reduced CSF levels of A beta42 and increased CSF levels of t-tau and p-tau in AD; the sensitivity and specificity of these data are able for discrimination of AD patients from controls. However, the specificity for other dementias is low. According to the literature analysis reported in the present review, we can conclude that the combination of the CSF markers and their ratios may significantly increase the specificity and the accuracy of AD diagnosis.     

Cerebrospinal fluid markers in differential diagnosis of Alzheimer's disease and vascular dementia

Alzheimer's disease (AD) and vascular dementia (VaD) are the two most common causes of dementia in old people. They remain difficult to differentiate in practice because of lack of sensitivity and specificity of current clinical diagnostic criteria. Recent molecular and cellular advancements indicate that the use of cerebrospinal fluid markers may improve early detection and differential diagnosis of AD. Our objective in this study was to determine diagnostic accuracy of three cerebrospinal (CSF) markers: total tau protein (t-tau), tau protein phosphorylated on threonine 181 (p-tau181) and tau protein phosphorylated on serine 199 (p-tau199). Using commercially available ELISA kits concentrations of t-tau, p-tau181 and p-tau199 were analyzed in 12 patients with probable AD, 9 patients with VaD and 12 NC subjects. The median levels of all three markers were significantly higher in AD group versus VaD and NC groups. However, when the sensitivity levels were set to 85% or higher, only t-tau and p-tau199 satisfied consensus recommendations (specificity more than 75%) when differentiating AD from VaD. In conclusion, our preliminary data on a small group of selected subjects suggest that the CSF t-tau and p-tau199 levels are useful markers for differentiating AD from VaD.     

Cerebrospinal fluid,plasma, and urinary MHPG in children

Cerebrospinal fluid (CSF) free MHPG levels for six autistic and four medicated Tourette Syndrome (TS) patients are in the usual adult range, but levels are elevated in two recently medicated TS patients. Plasma free MHPG levels in unmedicated autistic and TS patients are similar to those in normal boys, but are increased in two of seven medicated TS patients. There is a strong association between plasma free MHPG and urinary total MHPG levels in normal boys. Age and total urinary MHPG are positively correlated in autistic children. MHPG appears to be a useful index of noradrenergic function in childhood neuropsychiatric disorders.     

Cerebrospinal fluid flow increases from newborn to adult stages

Solute transport through the brain is of major importance for the clearance of toxic molecules and metabolites, and it plays key roles in the pathophysiology of the central nervous system. This solute transport notably depends on the cerebrospinal fluid (CSF) flow, which circulates in the subarachnoid spaces, the ventricles and the perivascular spaces. We hypothesized that the CSF flow may be different in the perinatal period compared to the adult period. Using in vivo magnetic resonance imaging (MRI) and near‐infrared fluorescence imaging (NIRF), we assessed the dynamic of the CSF flow in rodents at different ages. By injecting a contrast agent into the CSF, we first used MRI to demonstrate that CSF flow gradually increases with age, with the adult pattern observed at P90. This observation was confirmed by NIRF, which revealed an increased CSF flow in P90 rats when compared with P4 rats not only at the surface of the brain but also deep in the brain structures. Lastly, we evaluated the exit routes of the CSF from the brain. We demonstrated that indocyanine green injected directly into the striatum spread throughout the parenchyma in adult rats, whereas it stayed at the injection point in P4 rats. Moreover, the ability of CSF to exit through the nasal mucosa was increased in the adult rodents. Our results provide evidence that the perinatal brain has nonoptimal CSF flow and exit and, thus, may have impaired clean‐up capacity. © 2018 Wiley Periodicals, Inc. Develop Neurobiol, 2018     

Cerebrospinal fluid constituents of cat vary with susceptibility to motion sickness

Six female cats, varying in susceptibility to motion sickness, were implanted with chronic cannulae in the rostral portion of the fourth ventricle. The cats were then challenged with a motion sickness-inducing stimulus. Samples of cerebrospinal fluid were withdrawn before and after emesis or 30 min of motion if emesis did not occur and again on control (no motion) days. The samples were analyzed by HPLC with an array of 16 coulometric detectors. Thirty-six compounds were identified in the samples. Baseline levels of DOPAC, MHPGSO4, uric acid, DA, 5-HIAA and HVA were lower on motion and control days in cats which became motion sick when compared with cats which did not become motion sick. None of the identified compounds varied as a function of either exposure to motion or provocation of emesis. It is concluded that susceptibility to motion sickness is a manifestation of individual differences related to fundamental neurochemical composition.