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目的探讨HIV阴性的梅毒患者血清RPR滴度与神经梅毒的关系。方法回顾性分析2005年6月-2013年10月363例进行腰穿的HIV阴性梅毒患者的数据。应用卡方检验和逻辑回归分析神经梅毒的危险因素,应用ROC曲线分析血清反应素对神经梅毒的诊断价值。结果男性(OR 3.91,95%CI2.49~6.13,P<0.001)及血清RPR滴度与神经梅毒显著相关。血清RPR滴度每增高2倍,发生神经梅毒的几率增高1.39倍(校正OR 1.39,95%CI 1.24~1.55,P<0.001)。血清RPR滴度1∶16诊断神经梅毒时约登指数(0.288)最大,敏感性和特异性分别为43.70%和85.10%。血清RPR滴度诊断神经梅毒的ROC曲线面积为0.680。结论在HIV阴性人群中,尽管血清RPR滴度与神经梅毒显著相关,但以血清RPR滴度诊断神经梅毒容易造成大量患者的漏诊,其不适合作为判断是否需要进行腰穿的指标。
Objective To investigate the relationship between serum RPR titer and neurosyphilis in HIV-negative syphilis patients. Methods The data of 363 HIV-negative syphilis patients who underwent lumbar puncture between June 2005 and October 2013 were retrospectively analyzed. The risk factors of neurosyphilis were analyzed by chi-square test and logistic regression. The diagnostic value of serum CRP on neurosyphilis was analyzed by ROC curve. Results Male (OR 3.91, 95% CI 2.49 ~ 6.13, P <0.001) and serum RPR titer were significantly associated with neurosyphilis. Each 2-fold increase in serum RPR titer increased the risk of neurosyphilis by 1.39 times (OR 1.39, 95% CI 1.24-1.55, P <0.001). When RTP titer 1:16 was used to diagnose neurosyphilis, the maximal Yooden index (0.288) was 43.70% and 85.10% respectively. Serum RPR titer for diagnosis of neurosyphilis ROC curve area of 0.680. Conclusions In HIV-negative population, although serum RPR titer is significantly correlated with neurosyphilis, the diagnosis of neurosyphilis by serum RPR titer can easily lead to missed diagnosis in a large number of patients, which is not suitable as an index for judging the need for lumbar puncture.