中性粒细胞与淋巴细胞比值和RPR对无症状神经梅毒的预测作用

Predictive value of NLR and serum RPR for asymptomatic neurosyphilis

关键词:  无症状神经梅毒  血清快速血浆反应素试验  中性粒细胞/淋巴细胞比值

Key words:  asymptomatic neurosyphilis  rapid plasma reaction  neutrophil/lymphocyte ratio

摘要:

目的　探索中性粒细胞与淋巴细胞比值和血RPR对无症状神经梅毒发生的预测作用。方法　收集2016年1月至2018年1月在首都医科大学附属北京地坛医院神经内科住院进行腰椎穿刺的HIV阴性且无神经系统受累症状的梅毒患者共126例，其中无症状型神经梅毒患者59例，非神经梅毒的普通梅毒患者67例。记录两组患者年龄、性别、血清快速血浆反应素试验（RPR）、外周血中性粒细胞/淋巴细胞比值（NLR）、血小板/淋巴细胞比值（PLR）、脑脊液白细胞和脑脊液蛋白含量。绘制受试者工作特征曲线(ROC)，计算曲线下面积，评价NLR和血RPR的敏感度及特异度，计算Youden指数并确定诊断最佳截断值。结果　（1）无症状神经梅毒组血清RPR、NLR、脑脊液白细胞和脑脊液蛋白含量均高于非神经梅毒的普通梅毒组，差异有统计学意义［16（8～16）vs. 4（2～8）;(2.86±1.07) vs. (2.17±0.78)；10（7～18）vs. 2（2～4）；34（25.9～45.0）vs. 23.4（16.3～33.4），均P<0.05］。（2）NLR和血清RPR诊断无症状神经梅毒的曲线下面积分别为0.683、0.753，灵敏度分别为0.695、0.831，特异度分别为 0.672、0.552。结论　NLR和血RPR与神经梅毒密切相关。血NLR在预测无症状神经梅毒的特异度高于血RPR。高水平NLR（NLR≥2.22）在一定程度上可以预测无症状神经梅毒的发生。

Abstract:

Objective　To investigate the predictive value of NLR and serum RPR for neurosyphilis in asymptomatic patients. Methods　Totally 126 HIV-negative syphilis patients were enrolled into this study, who underwent lumbar puncture in the Department of Neurology from January 2016 to January 2018 at Beijing Ditan Hospital, Capital Medical University. The study included 59 asymptomatic neurosyphilis patients and 67 non-neurosyphilis patients. Clinical data on age, sex, serum rapid plasma reaction (RPR), peripheral blood neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), cerebrospinal fluid RPR, cerebrospinal fluid white blood cells (WBCs) and cerebrospinal fluid protein were collected. The receiver operating characteristic (ROC) curve was used to evaluate the sensitivity and specificity of the independent risk factors. The Youden index was calculated and the optimal cut-off value was determined．Results　The serum levels of RPR and NLR, cerebrospinal fluid WBCs and cerebrospinal fluid protein in asymptomatic neurosyphilis group were higher than those in the non-neurosyphilis group, and the difference were statistically significant［16 (8-16) vs. 4 (2-8); (2.86±1.07) vs. (2.17±0.78); 10 (7-18) vs. 2 (2-4); 34 (25.9-45.0) vs. 23.4 (16.3-33.4), all P<0.05］. The area under the ROC curve of the NLR and serum RPR levels at admission were 0.683 and 0.753. The sensitivity were 0.695 and 0.831. The specificity were 0.672 and 0.552. Conclusions　NLR and serum RPR are closely related to asymptomatic neurosyphilis. The specificity of NLR in predicting asymptomatic neurosyphilis is higher than serum RPR. The higher NLR（NLR≥2.22）at admission may predict asymptomatic neurosyphilis.