表现为视神经病变的眼部梅毒8例临床分析  

Clinical analysis of 8 cases of ocular syphilis presenting with optic neuropathy

作　　者：李漫丽[1] 李翔[1] 范珂[1] LI Manli;LI Xiang;FAN Ke(Henan Eye Hospital,Henan Eye Institute,Henan Province People's Hospital,ZhengZhou 450003,China)

机构地区：[1]河南省眼科研究所河南省立眼科医院河南省人民医院,郑州450003

出　　处：《中国实用眼科杂志》2018年第1期28-31,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的 探讨以视神经损害为主要表现的眼部梅毒的临床特点.方法 回顾分析2012年1月至2016年12月在河南省人民医院眼科诊治的表现为视神经病变的8例(15只眼)梅毒患者的临床资料.结果 8例患者均以眼部症状为首发症状,以梅毒Ⅰ期、Ⅱ期居多;7例患者双眼同时或先后发病;就诊时最佳矫正视力:光感~0.7;3例患者表现为“双眼视乳头水肿”,1例为“左眼视乳头水肿”,4例为“视神经萎缩”“视神经病变”;眼底视盘水肿程度为轻度至中度隆起,视野缺损无特异性,出现多种形式的视野缺损;所有患者均无脑膜刺激征等伴随症状;头部MRI结果均无异常;病程早期的患者有血清学炎性指标如血沉、C反应蛋白(CRP)、抗链球菌溶血素O(ASO)、纤维蛋白原的升高;给予驱梅治疗1周后,7例患者视力有提高.结论 视神经损害可为梅毒的首发症状,且为无特异性的唯一表现,及时治疗可避免视功能丧失.Objective To investigate the clinical features of ocular syphilis with optic nerve damage Methods The clinical data of 8 cases (15 eyes) syphilis with optic neuropathy in our hospital from January 2012 to December 2016 were retrospectively analyzed;Results All the 8 patients had ocular symptoms as the first symptom,and the majority of them were phase Ⅰ and phase Ⅱ syphilis;Best corrected visual acuity:light sensation ~0.7;3 patients presented with bilateral optic papilla edema,3 patient with left eye optic papilla edema,and the optic nerve atrophy in 4 cases;The degree of optic disc edema was mild to moderate,and the visual field defect was not specific.Various forms of visual field defects were observed.All patients had no symptoms of meningeal irritation,and no abnormal MRI findings were observed.In the early stage of the disease,the serum inflammatory markers such as erythrocyte sedimentation rate,CRP,ASO and fibrinogen were increased.After 1 weeks of antisyphilitic treatment,the visual acuity of the patients in the treatment group was improved in 7 cases.Conclusions Optic nerve injury can be the first symptom of syphilis,and is the only manifestation of nonspecific.Timely treatment can avoid loss of visual function.

关 键 词：梅毒 视神经 临床特点 

分 类 号：R759.1[医药卫生—皮肤病学与性病学] R774.6[医药卫生—临床医学]