Abstract：
Serology is the mainstay for syphilis treatment monitoring. Baseline rapid plasma reagin (RPR) titre, HIV status, and syphilis stage have been found to be associated with the time to serological response among syphilis patients. This study mainly aims to evaluate the time to serological response, and to identify factors affecting the serological outcome. Medical records of syphilis cases diagnosed in Peking Union Medical College Hospital (PUMCH) between 2008 and 2018 were retrospectively reviewed. Kaplan-Meier analysis was performed to evaluate the median time to serologic response and cumulative probability of serologic response over time according to different variables. Cox regression model was conducted to find factors associated with serological response. There were 984 patients diagnosed with primary, secondary, or latent syphilis cases and receiving injections of benzathine penicillin G (BPG) as initial treatment at the Peking Union Medical College Hospital (PUMCH) between 2008 and 2018. Finally, data on 571 patients, including 49 (8.6%) primary syphilis, 261 (45.7%) secondary syphilis, and 261 (45.7%) latent syphilis, were used for analysis. It took longer time to achieve serological response for subjects aged ≥45 years than younger individuals (89 days versus 58 days; p=0.008). Males achieved serological response more quickly than females (71 days versus 83 days; p = 0.011). There was a significant difference in the time to serological response according to different syphilis stages (p < 0.001), with 55 days (95% CI, 43-67 days) for primary, 57 days (95% CI, 51-63 days) for secondary, and 117 days for latent syphilis. In addition, patients with lower baseline RPR titre had longer period to achieve serological response (252 days [95% CI, 129-375 days] for RPR titre ≤1:8, 78 days [95% CI, 63-93 days] for RPR titres from 1:16 to 1:32, and 53 days [95% CI, 49-57 days] for RPR titres ≥1:64, respectively; p<0.001). However, no significant difference in time to serological response to treatment was found according to HIV coinfection status. The result of multivariate Cox regression analysis showed that being older than 45 years with latent syphilis, HIV coinfection, or with baseline RPR titre ≤1:8 was associated with slow response. Among patients followed for at least 1 year or seroreverted, 128 (36.9%) had seroreverted within a year, and 219 (63.1%) still had a positive RPR after 1 year. For multiple logistical regression, being female and HIV coinfection were significantly associated with the failure of seroreversion (OR, 0.42 [95% CI, 0.26-0.68]; p <0.001). This study revealed that younger age, higher initial RPR titre, early syphilis stage, and HIV-negative status were associated with faster serological cure. Female sex, individuals with HIV coinfection, and latent syphilis were significantly associated with the failure of seroreversion.
摘要：
血清学是梅毒治疗监测的主要手段。基线快速血浆反应素（RPR）滴度，艾滋病毒状况，梅毒分期与梅毒患者的血清学反应时间有关。本研究主要旨在评估血清学反应的时间，并确定影响血清学结果的因素。回顾性分析2008年至2018年在北京协和医院（PUMCH）诊断的梅毒病例的病历。进行Kaplan-Meier分析以根据不同变量评估血清学反应的中位时间和血清学反应随时间的累积概率。采用Cox回归模型寻找与血清学反应相关的因素。有984例患者被诊断为原发性，次要,或潜伏梅毒病例，并在2008年至2018年期间在北京协和医院（PUMCH）接受注射苄星青霉素G（BPG）作为初始治疗。最后,571名患者的数据，包括49例(8.6%)原发性梅毒，261（45.7%）二期梅毒，和261（45.7％）潜伏梅毒，用于分析。与年轻人相比，年龄≥45岁的受试者需要更长的时间才能达到血清学反应（89天对58天；p=0.008）。雄性比雌性更快地实现血清学应答(71天对83天;p=0.011)。根据不同的梅毒分期，血清学反应的时间存在显着差异（p<0.001），55天（95%CI，43-67天）为主要，57天（95%CI，51-63天）为次要，潜伏期梅毒为117天.此外,基线RPR滴度较低的患者获得血清学应答的时间更长(RPR滴度≤1:8时252天[95%CI,129~375天],RPR滴度为1:16~1:32时78天[95%CI,63~93天],RPR滴度≥1:64时53天[95%CI,49~57天];p<0.001).然而,根据HIV合并感染状态，对治疗的血清学反应时间没有显着差异。多因素Cox回归分析结果显示,年龄大于45岁的潜伏性梅毒,艾滋病毒合并感染，或基线RPR滴度≤1:8与慢反应相关。在随访至少1年或血清转化的患者中，128人(36.9%)在一年内进行了血清学转换，1年后仍有219人(63.1%)的RPR为正。对于多元逻辑回归，女性和HIV合并感染与血清逆转失败显著相关(OR，0.42[95%CI，0.26-0.68]；p<0.001）。这项研究表明，年龄较小，较高的初始RPR滴度，早期梅毒阶段，HIV阴性状态与更快的血清学治愈相关。女性性别,合并感染艾滋病毒的人，潜伏梅毒与血清学转化失败显著相关。
