以痴呆为突出表现的神经梅毒系统分析  

Dementia as the typical manifestation of neurosyphilis： a systematic analysis

作　　者：张静[1] 黎平[1] 施辛[1] 刘润秋[1] 闫志华[1] 蔡永莲[1] 孙晓东[1] 

机构地区：[1]苏州大学附属第二医院皮肤科,215004

出　　处：《中华神经医学杂志》2011年第6期637-640,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨以痴呆为突出表现的神经梅毒的临床特征及其治疗方法和预后，以期提高对该病的诊治水平。方法计算机检索中国生物医学文献数据库fCBM）和Medline．对1989年至今国内外文献中公开发表的以痴呆为突出表现的梅毒患者的病历资料（病例报告形式1进行回顾性分析。结果纳入44篇文献共62例患者（61例麻痹性痴呆及1例梅毒性精神神经病患者），其临床特征包括：（1）男性多见；（2）多数隐匿起病；（3）首发症状以记忆力减退和性格改变多见；（4）MRI、CT以脑萎缩为主；（5）血清、CSF梅毒抗体检查阳性，也可有特殊情况；（6）确诊较困难；（7）驱梅治疗近期症状可不同程度改善；（81远期预后证据缺乏。结论（1）麻痹性痴呆和梅毒性精神神经病均可有痴呆表现；（2）原因不明的痴呆患者应常规行梅毒血清学及脑脊液检查；（3）驱梅结合对症治疗大多近期疗效好；f4）需长期随访观察远期疗效。Objective To study the clinical features, therapy and prognosis of neurosyphilis typically manifested as dementia to improve its diagnosis and treatment. Methods A retrospective analysis of patients with neurosyphilis typically manifested as dementia, searched in Medline and Chinese Biomedical Literature Datebase （CBM） from 1989 to 2010, was performed. Results Forty-four studies involving 62 patients （61 cases of general paresis and 1 case of syphilitic psychoneurosis） were evaluated; the clinical features of them included the follows： male are more common; most of them had insidious onset; memory impairment and personality changes were the first common symptoms; diffuse cerebral atrophy was found in MRI and CT; serum and cerebrospinal fluid （CSF） syphilis antibody reaction was positive with some exceptional case; definite diagnosis was difficult; after anti-syphilitic therapy, symptoms could be improved more or less in a short time; and evidence of long-term prognosis was insufficient. Conclusion Both general paresis and syphilitic psychoneurosis could cause dementia. Dementia patients should be given serum and CSF syphilis antibody examination routinely if the causes of dementia are unknown. Anti-syphilitic and symptomatic treatments mostly enjoy good curative effects in a short term. Close follow-up is necessary in observing the forward effects.

关 键 词：痴呆 神经梅毒 系统分析 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]