앞선 글 (매독 검사, 매독 진단을 위한 혈액 검사의 모든 것) 에서 매독 진단을 위한 혈액 매독 검사에 대해 소개하였다.
이번 글에서는 신경 매독 진단을 위한 뇌척수액 매독 검사(CSF VDRL)와 그 해석에 대해서 알아보도록 하겠다.
신경 매독이란
신경매독은 매독에 의해 발생하는 신경계 질환을 통칭하는 것으로 주로 3기 매독에서 관찰된다. 많은 수의 환자에서 무증상을 보이고 증상을 발현하는 경우 임상양상에 따라 급성 매독성 수막염 (acute syphilitic meningitis) / 수막혈관성 신경매독 (meningovascular neurosyphilis) / 실질형 신경매독 (parenchymatous neurosyphilis)의 3가지로 나눌 수 있다.
뇌척수액 매독 검사 (CSF VDRL)의 정의
뇌척수액은 영어로 CSF라고 하며, 이는 cerebrospinal fluid의 약자이다. 즉, 뇌척수액 검체로 nontreponemal 매독 검사를 하는것이 CSF VDRL 검사이다.
1기나 2기매독, 조기 잠복매독의 경우 보통 뇌척수액 검사를 할 필요가 없지만, 조기 매독인 경우에도 뇌수막염 에 해당하는 증상이 있는 경우에는 뇌척수액 검사가 필요하며, 검사 결과 이상이 있는 경우 신경 매독에 준해 치료해야 한다.
뇌척수액 매독 검사 (CSF VDRL)가 필요한 경우
일반적으로는 후기 잠복 매독에서 뇌척수액 검사가 필요한 다음과 같은 경우에 CSF VDRL 검사를 시행하게 된다.
- RPR titer 1:32 이상
- 신경학적 증상이나 증후가 하나라도 있는 경우 (뇌신경 마비, 청신경이나 이신경 이상, 뇌수막염, 뇌졸중, 의식 저하, 진동감각 이상 등)
- human immunodeficiency virus (HIV) 양성인 경우
위와같은 적응증에 해당하는 경우에는 CSF VDRL 검사, FTA-ABS, cell count with analysis, protein, glucose 검사를 해야한다.
CSF VDRL은 신경 매독 진단에 매우 특이적으로 이 검사에서 양성인 경우 신경 매독을 진단할 수 있다. 하지만, 민감도가 22-69%로 낮기 때문에 음성이라도 신경 매독을 배제할수는 없다.
CSF VDRL 검사의 판독
CSF VDRL 검사의 판독은 간단하다. 검체를 1:1, 1:2, 1:4, 1:8, 1:16 등으로 순차적으로 희석하여 어디까지 응집이 있는지를 현미경으로 확인한다.
위 사진에서, 왼쪽은 응집이 없는 경우로 음성으로 판정, 오른쪽은 응집이 있는 경우로 양성으로 판정하여 희석 배수와 함께 역가를 보고한다.
뇌척수액 매독 검사(CSF VDRL)의 임상적 의의
뇌척수액 매독 검사(CSF VDRL)는 매독 진단을 위한 혈액 검사가 양성이거나, 매독성 수막염과 같은 신경매독 진단을 의심할 만한 증상이 있는 경우 신경매독 진단을 위해 시행된다. 이는 매독이 신경계를 침범하는 신경매독에서 강한 진단적 가치를 가지기 때문이다. 뇌척수액 검체에서의 양성 반응은 매독균의 감염이 신경계에 침범하고 있다는 것을 나타내며, 이는 매독의 치료와 예방에 중요한 의미를 가진다.
뇌척수액 매독 검사(CSF VDRL)의 한계와 대안 검사
뇌척수액 매독 검사는 신경매독 진단을 위한 가장 일반적인 검사 중 하나이지만, 민감도가 22-69%로 낮기 때문에 음성 결과가 신경매독을 배제할 수 없다는 한계가 있다. 따라서 다른 검사와 함께 사용하여 진단적 가치를 높일 필요가 있다.
대안으로 사용되는 검사에는 FTA-ABS 검사와 매독균 전용 PCR 검사 등이 있다. FTA-ABS 검사는 매독균 감염에 대한 면역학적 반응을 측정하는 검사로, 높은 감도와 특이도를 보인다. 매독균 전용 PCR 검사는 DNA 증폭 기술을 이용하여 직접 매독균의 유전자를 감지하는 방법으로, 민감도와 특이도가 높은 장점이 있다. 이러한 검사들은 뇌척수액 매독 검사와 함께 사용하여 신경매독 진단의 정확도를 높일 수 있다.
함께 읽으면 좋은 글: 매독 검사, 매독 진단을 위한 혈액 검사의 모든 것
매독이 신경에도 침투하는군요
신경매독은 무시무시한 질병이라 빠른 진단이 중요하겠습니다.
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