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目的探讨系统性红斑狼疮(SLE)合并潜伏梅毒的临床特点。方法回顾性分析了6例SLE合并潜伏梅毒患者的临床资料。结果 6例患者均为女性,血浆反应素环状卡片试验(RPR)和梅毒螺旋体明胶颗粒凝集试验均阳性。其中4例发现于确诊SLE后3月～1年,2例发生于确诊SLE前。患者均未减少或停用皮质类固醇激素和免疫抑制剂,同时给予头孢曲松0.25g肌肉注射,1次/d,15d为1疗程。2例患者在治疗后1年血清RPR转阴,3例RPR滴度下降4倍以上,后长期稳定在1∶2阳性。1例患者血清RPR滴度呈增高趋势,予苄星青霉素240万U,1次/周,共3次。治疗后患者红斑狼疮病情加重,但血清RPR滴度持续下降。结论 SLE合并潜伏梅毒非常罕见,诊断和治疗较难。头孢曲松可作为较好的替代治疗药物,但需密切观察和随访治疗效果,必要时改用苄星青霉素治疗,并注意有加重SLE病情的可能。
Objective To investigate the clinical features of systemic lupus erythematosus (SLE) complicated with latent syphilis. Methods The clinical data of 6 patients with SLE complicated with latent syphilis were retrospectively analyzed. Results All the 6 patients were female. Plasma RPR and TRP were positive. Four of them were found in 3 months to 1 year after diagnosis of SLE, and 2 cases occurred before the diagnosis of SLE. Patients did not reduce or disable corticosteroids and immunosuppressive agents, given ceftriaxone 0.25g intramuscular injection, 1 / d, 15d for a course of treatment. Serum RPR was negative in 2 patients 1 year after treatment, and the RPR titer in 3 patients dropped more than 4 times, and then it was stable at 1: 2 after long-term. Serum RPR titers showed an increasing trend in 1 patient, and 2,400 U of benzathine penicillin was given once a week for 3 times. Lupus erythematosus patients exacerbated after treatment, but serum RPR titer continued to decline. Conclusion SLE complicated with latent syphilis is very rare, diagnosis and treatment more difficult. Ceftriaxone can be used as a good alternative treatment, but close observation and follow-up treatment, if necessary, switch to benzathine penicillin treatment, and pay attention to aggravate the possibility of SLE.