建立无腰椎穿刺神经梅毒的临床预测模型

IF 2.9 4区医学 Q2 CELL BIOLOGY

Cellular immunology Pub Date : 2025-08-16 DOI:10.1016/j.cellimm.2025.105012

Xuebi Wang , Wei Wang , Yabin Liu , Peng Wang , Qin Huang , Di Tian , Yixin Liao , Zhigang Yi , Feng Li , Yuanjia Tang , Chen Zhao , Xiaohong Fan , Yun Ling

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引用次数: 0

摘要

目的神经梅毒（NS）可引起一系列中枢神经系统（CNS）损伤，从无症状状态到严重的精神障碍。虽然腰椎穿刺是一种可靠的NS诊断方法，但由于其侵入性，特别是对症状轻微的患者，通常不太被接受。本研究旨在建立一种不需要腰椎穿刺的NS早期诊断预测模型。方法收集上海市公共卫生临床中心2021 - 2023年的临床资料，包括影像学检查、血常规检查、免疫标志物、HIV检测和脑脊液检测。数据集以8:2的比例随机分为训练集和验证集。单变量分析、最小绝对收缩和选择算子（LASSO）和多变量逻辑回归用于识别显著的预测因子。结果在1078例疑似梅毒患者中，筛选出梅毒螺旋体特异性抗体（anti-TP）阳性、梅毒螺旋体颗粒凝集（TRUST）阳性的梅毒确诊患者702例。其中CSF anti-TP阳性246例诊断为NS，非神经梅毒（NNS） 456例。在NS组中，发现脑缺血/梗死、共济失调、视力下降、精神/行为障碍、记忆障碍、抗tp和TRUST水平高（>1:16）、红细胞（RBC）和血小板（PLT）计数升高、凝血酶原时间（PT）缩短。建立了基于独立预后因素的nomogram。受试者工作特征（ROC）曲线和校准曲线预测准确度较高，临床决策曲线分析（DCA）具有较好的临床适用性。结论无论梅毒患者是否感染HIV或免疫状况如何，本方法均可作为早期诊断梅毒患者NS的可靠、无创方法。

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Establishing a clinical prediction model of neurosyphilis via a lumbar-puncture-free nomogram

Objectives

Neurosyphilis (NS) can cause a range of central nervous system (CNS) damage, from asymptomatic states to severe mental disorders. While lumbar puncture is a reliable diagnostic method for NS, it is often poorly accepted due to its invasive nature, particularly by patients with mild symptoms. This study aims to develop a prediction model for the early diagnosis of NS that without requiring lumbar puncture.

Methods

Clinical data, including imaging, routine blood tests, immune markers, HIV status and cerebrospinal fluid (CSF) examination, were collected from the Shanghai Public Health Clinical Center from 2021 to 2023,. The dataset was randomly split into training and validation sets in an 8:2 ratio. Univariate analysis, the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression were used to identify significant predictors.

Results

Out of 1078 suspected patients, 702 confirmed syphilis patients with positive Treponema pallidum specific antibody (anti-TP) and positive Treponema Pallidum Particle Agglutination (TRUST) in serum were selected. Among them, 246 patients were diagnosed as NS based on the positive anti-TP in CSF, while 456 patients were classified as non-neurosyphilis (NNS). In the NS group, cerebral ischemia/infarction, ataxia, decreased vision, mental/behavioral disorders, memory impairment, high levels of anti-TP and TRUST (>1:16), elevated red blood cell (RBC) and platelet (PLT) counts, and shorter prothrombin time (PT) were identified. A nomogram was established based on independent prognostic factors. The receiver operating characteristic (ROC) curves and calibration curves showed high predictive accuracy, and clinical decision curve analysis (DCA) indicated good clinical applicability.

Conclusions

The developed nomogram offers a reliable and non-invasive method for early identification of NS in syphilis patients, regardless of their HIV or immune status.

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来源期刊

Cellular immunology 生物-免疫学

CiteScore

8.20

自引率

2.30%

发文量

102

审稿时长

30 days

期刊介绍： Cellular Immunology publishes original investigations concerned with the immunological activities of cells in experimental or clinical situations. The scope of the journal encompasses the broad area of in vitro and in vivo studies of cellular immune responses. Purely clinical descriptive studies are not considered. Research Areas include: • Antigen receptor sites • Autoimmunity • Delayed-type hypersensitivity or cellular immunity • Immunologic deficiency states and their reconstitution • Immunologic surveillance and tumor immunity • Immunomodulation • Immunotherapy • Lymphokines and cytokines • Nonantibody immunity • Parasite immunology • Resistance to intracellular microbial and viral infection • Thymus and lymphocyte immunobiology • Transplantation immunology • Tumor immunity.