The expression of cytokines in the cerebrospinal fluid of patients with neurosyphilis and analysis of its diagnostic value
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摘要:
目的：分析脑脊液（cerebrospinal fluid，CSF）中的白细胞介素-1受体拮抗剂（interleukin-1 receptor antagonist，IL-1ra）、趋化因子I-TAC/CXCL11和巨噬细胞炎性蛋白-1α（macrophage inflammatory protein-1α，MIP-1α）对神经梅毒的诊断价值。方法：选择2018年4月—2019年12月南京市第二医院皮肤性病科50例神经梅毒患者和50例梅毒患者作为研究对象。神经梅毒患者均给予常规对症治疗及全程驱梅治疗。通过酶联免疫吸附试验（enzyme linked immunosorbent assay，ELISA）试剂盒对CSF中的IL-1ra、I-TAC/CXCL11和MIP-1α进行检测。采用美国国立卫生研究院卒中量表（National Institute of Health stroke scale，NIHSS）评估患者的神经功能。结果：与梅毒患者相比，神经梅毒患者的脑脊液IL-1ra、I-TAC/CXCL11和MIP-1α水平均升高（P < 0.001）。与早期神经梅毒患者相比，晚期神经梅毒患者的脑脊液IL-1ra水平升高（P < 0.01）。但早期和晚期患者的脑脊液I-TAC/CXCL11和MIP-1α水平无显著差异（P > 0.05）。神经梅毒患者脑脊液IL-1ra水平与1/血清快速血浆反应素试验（rapid plasma reagin，RPR）滴度、CSF蛋白和CSF白细胞计数均显著正相关（P < 0.05）。脑脊液I-TAC/CXCL11和MIP-1α水平与1/血清RPR滴度和CSF蛋白显著正相关（P < 0.05）。与治疗前相比，患者治疗后的脑脊液IL-1ra、I-TAC/CXCL11和MIP-1α水平均降低（P < 0.001）。脑脊液IL-1ra、I-TAC/CXCL11和MIP-1α联合诊断神经梅毒的曲线下面积、敏感性和特异性依次为0.91、94.0%和88.0%。结论：IL-1ra、I-TAC/CXCL11和MIP-1α是诊断神经梅毒的潜在生物标志物，可用作神经梅毒的辅助诊断工具，并且可用于监测神经梅毒的治疗效果。
Abstract:
Objective：To reveal the diagnostic value of interleukin-1 receptor antagonist（IL-1ra），chemokine I-TAC/CXCL11 and macrophage inflammatory protein-1α（MIP-1α） in cerebrospinal fluid（CSF） for neurosyphilis. Methods：From April 2018 to December 2019，50 patients with neurosyphilis and 50 patients with syphilis were selected as the research objects. Patients with neurosyphilis were given conventional symptomatic treatment and full treatment of syphilis. The IL-1ra，I-TAC/CXCL11 and MIP-1α in CSF were detected by enzyme linked immunosorbent assay（ELISA） kit. The National Institutes of Health stroke scale（NIHSS） was used to evaluate the neurological function of patients. Results：Compared with patients with syphilis，the levels of IL-1ra，I-TAC/CXCL11 and MIP-1α in neurosyphilis patients were increased（P < 0.001）. Compared with early neurosyphilis patients，the level of IL-1ra in the cerebrospinal fluid of patients with advanced neurosyphilis increased（P < 0.01）. However, there was no significant difference in the levels of I-TAC/CXCL11 and MIP-1α in cerebrospinal fluid between early stage and late stage patients（P > 0.05）. The level of IL-1ra in cerebrospinal fluid of patients with neurosyphilis was significantly positively correlated with 1/serum rapid plasma regain（RPR） titer，CSF protein and CSF-WBC（P < 0.05）. Cerebrospinal fluid I-TAC/CXCL11 and MIP-1α levels were significantly positively correlated with 1/serum RPR titer and CSF protein（P < 0.05）. Compared with before treatment，the levels of IL-1ra，I-TAC/CXCL11 and MIP-1α in the cerebrospinal fluid of patients after treatment decreased（P < 0.001）. The AUC，sensitivity and specificity of IL-1ra，I-TAC/CXCL11 and MIP-1α in cerebrospinal fluid for the combined diagnosis of neurosyphilis were 0.91，94.0% and 88.0%， respectively. Conclusion：IL-1ra，I-TAC/CXCL11 and MIP-1α are potential biomarkers for the diagnosis of neurosyphilis. They can be used as auxiliary diagnostic tools for neurosyphilis and monitoring the therapeutic effect of neurosyphilis.
