【作者】 李秋涛；

【作者基本信息】 郑州大学 ， 免疫学， 2002， 硕士

【摘要】 梅毒(syphilis)是由苍白螺旋体(Treponema pallidum)引起的慢性系统性传染病，属于性传播疾病(sexually transmitted disease，STD)，是经典性病的一种。临床表现甚为复杂，在其长期慢性过程中，症状显发与重复的潜伏相互交替。早期梅毒(感染在2年以内)传染性较大，是梅毒的主要传染源，病程越长，传染性越小，晚期梅毒(感染在2年以上)虽传染性小，但组织破坏严重。梅毒可累及全身任何组织器官，甚至可以造成残废。由于梅毒螺旋体体外培养困难，对其各方面的研究均受到限制，故其发病机制尚不完全清楚。治疗上一般采用1981年WHO提出的梅毒治疗方案，青霉素为治疗梅毒的首选药物，根据病程、病情的不同，所用剂量、疗程有所不同。近年来，随着国内梅毒患者发病率的逐年增高，有关该病的研究亦日益 一 增多。但相关研究多集中于梅毒的血清学检测及梅毒螺旋体抗 原性方面，而对梅毒患者本身的免疫状态却少有关注。虽然至 今尚未见到有关梅毒螺旋体对青霉素耐药的报道，但临床观察 发现，对于同样的治疗方案，患者皮损消退及快速血浆反应素 环状卡片试验（rapt plasma regain card test，RPR）转阴结果是不 一样的，从而考虑到每个患者自身免疫功能的差异。近年来， 免疫学的进展虽然很快，而在梅毒免疫学方面却进展不多。因 此人体感染梅毒螺旋体后的免疫反应性质目前仍不十分清楚，” 但确与体液免疫和细胞兔疫密切相关，这己从临床表现或动物 实验方面得到证实。本研究从细胞免疫的角度探讨患者的免疫功能状态，研究其与病期、疗效间的关系，以期为更有效的治疗及预后判定提供帮助。 材料与方法 通过流式细胞仪，运用标有异硫氰酸荧光素muoresceinlsothlocyanate，FITC）或藻红素（phycolerythrin，PE）的聚类分化抗原（cluster of differentiation，CD）单抗，检狈了 46例梅毒患者治疗前、后及20例正常人外周血T淋巴细胞免疫表型，同时应用双抗体夹心ELISA法对同样对象测定了血清IL上及JL上 水平。将治疗后三个月血清RPR阴转的患者设定为A组，未阴转的患者设定为B组。分析了梅毒患者与正常对照组细胞免疫功能的不同；不同病期梅毒患者的细胞免疫功能的差别；以及不同的细胞兔疫功能与不同治疗效果间的关系。对实验数据应用蚊SS门 刀）软件系统进行统计学处理，计量资料用Z朽表示，多组资料比较采用方差分析，多个均数间的两两郑州大学2002硕士学位论文 梅毒患者圳胞免疫功能的检测及其临床悬义比较用q检验，两样本均数比较用矿检验，方差不齐时用矿’检验，治疗前后用配对t检验，以P＜0刀5作为差异有显著性。 结果 1．梅毒患者治疗前细胞免疫功能与正常对照组比较：CD。”、CD。”。N’K（CD；。”，CD，。“）细胞百分比、CD。”／CDs“比值及血清L上水平明显降低（P叱．of）；CD。”细胞百分比、血清SI＊－ZR水平均明显升高（P＜0刀1）。 2．各期梅毒患者治疗前细胞免疫功能与正常对照组比较 一期梅毒思者治疗前细胞兔疫功能与正常对照组相比：CD3“、CD4”细胞百分比、CD4”／CDS”L值明显降低（P＜0刀 1）；CD／细胞百分比、血清IL上及血清SIL2 水平明显升高 （P1刀1＼NK细胞百分比，两组相比差异无显著性意义 （＞0．05）。 二期梅毒患者治疗前细胞兔疫功能与正常对照组相比：CD厂、CD。”、NK细胞百分Lll、CD。、CDs”［if值＆血清几－2水平降低，差异均有显著性意义p刃＊）；CDS“细胞百分比及血清 SIL上 水平升高，差异均有显著性意义o1刀 1人 潜伏梅毒患者治疗前细胞免疫功能与正常对照组柏比：CD。十、CD。“、NK细胞百分比、CD。”／CD。“比值降低，差异有显著性意义o＜0．of人 CDs”细胞百分比、血清dL上 水平升高，差异有显著性意义0刃刀1＼卜2水平略降低，差异无显著性意义（P＞0刀5）。 3．各期梅毒组治疗前细胞免疫功能组间的两两比较 一期、二期及潜伏期之间的各项指标比较显示：CD／、CD。’ 3—— 细胞百分比及CD／CDs1值，三组患者之间无明显差异 0＞0刀5＼＊山“细胞百分比：二期及潜伏期组明显高于一期梅 毒组o叼刀1＼ 细胞百分比：二期梅毒组低于一期及潜伏 期组o1们人1卜2水平：一期梅毒组显著高于二期及潜伏期组0功．01），h期梅毒组显著低于一期及潜伏期组01．01）； SIL上 水平：h期梅毒组明显高于一期及潜伏期组0＜0．of人 4．A组（治疗后三个月RPR阴转组）患者治疗前、后细 胞免疫功能的变化 A组患者治疗前细胞免疫功能与正常对照组相比：CD厂。CD。”细胞百分 Lll、CD。YCD。”Lh值降低（P＜0．01），CDs”细胞 i分比、血清 SIL上 升高①叼刀 1），NK细胞百分比及血清 IL上水平差异无显著性意义o叩刀5人 A组治疗后的细胞免疫功能与正常?更多还原

【Abstract】 Syphilis, caused by Treponema pallidum^P), is a chronically, systematically and sexually transmitted disease(STD) with complicated clinic exhibition. During the long and chronic course of disease, patient’s apparent symptoms alternate with latency ones. The early stage syphilis (less than 2 years), due to its strong infectivity is the main source of infection. Nevertheless, the advanced stage syphilis (more than 2 years), though the tissue destroyed seriously, comparatively has a little of infectivity. The longer the course of the disease has, the weaker the infectivity is. Syphilis can destroy every tissue or organic on people’s body and even lead to lameness. Up to now , the real mechanism of this disease has not be found. The general treatment to syphilis isrecommended by WHO in 1981 is to use penicillin as the first choice only vary in dosage and period of treatment according to different course of disease and state of illness.In recent years, along with the increasing incidences of domestic syphilis, more and more attention is paid to such disease. The study to this disease is mostly concentrated on the serum detection and antigen of Treponema pallidum for syphilis patient, few attention is paid to the immunity function of syphilis patient. However, in our clinical practice, disappearance destroyed skill and RPR seronegative differed from one patient to another under the same treatment, which made us consider and study whether or not that result was caused by the individual immunity difference. In recent years , though immunology progress greatly, the study to syphilis immunology has little advance. The immunity principle has not been cleared after patients receiving Treponema pallidum, but the close relationship between syphilis and immunity is clear. It is not difficulty to see from clinical that the course of disease is related to humoral immunity and cellular immunity no matter that is proved by either clinical expression or animal test. This dissertation, from the point of view of cellular immunity, studied the syphilis patient’s immunity function and the relationship between the course of disease and treatment results so that it can be of much help to the more effective treatment and prognosis judgement.Materials and methods:With flow cytometry, using CD monoclonal antibodies labled by either fluorescein isothiocyanate (FITC) or phycolerythrin(PE), special feature of peripheral blood lymphocyte immunophenotypes (PBLI) was detected through pre-treatment and post-treatment of 46 cases of syphilitic patients and 20 cases of normal persons. Meanwhile, the same patients’ IL-2 and sIL-2R serum level was detected by the ELISA method. After three month treatment, patients were divided into two groups according to their RPR result: group A, the seronegative; and group B, the seropositive. This report analyzed the difference of cellular immunity function between syphilis patients and normal group, and the one difference cellular immunity function among different courses of disease, even more the relationship between the different cellular immunity function and the different treatment results. Experiment data were statistically processed by computer with SPSS(10.0) software system, measure data were presented by x + s, analysis of variance(ANOVA)were used for multigroup materials and g-test were used to examine the discrepancy of multiple comparisons in multimeans , two sample means with Mest or t’-test to examine the notable discrepancy, pair Mest were used to examine the discrepancy of before and after treatment. Probability values less than 0.05 were considered statistically significant.Results:1 . Compared the cellular immunity function of syphilis patient before treatment with normal control persons’, CD3+ cells, CD4+ cells, the ratio of CD4+/CD8+, NK(CD,6+, CD56+ )cells and the level of IL-2 in syphilic patients were significantly decreased ( P<0.01); but CD8+ cells and the level of sIL-2R significantly increased (P<0.01).2. The comparison cellular immunity function of syph更多还原