梅毒性脑动脉炎性脑梗死与动脉粥样硬化性脑梗死的临床对比分析  

Comparative analysis of clinical manifestations of syphilis cerebrovascular infarction andatherosclerotic cerebrovascular infarction

作　　者：冯小云 莫雪安[2] 覃华宏 

机构地区：[1]武警广西总队医院神经内科,南宁530003 [2]广西医科大学第一附属医院神经内科,南宁530021

出　　处：《中华神经医学杂志》2016年第7期664-668,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨梅毒性脑动脉炎性脑梗死与动脉粥样硬化性脑梗死的临床鉴别方法。方法回顾性分析广西医科大学第一附属医院神经内科自2008年2月至2014年8月收治入院的20例梅毒性脑动脉炎性脑梗死患者（梅毒组）及80例动脉粥样硬化性脑梗死患者（粥样硬化组）患者的临床表现、实验室检查结果及影像学检查结果。结果与粥样硬化组患者比较，梅毒组患者起病年龄较低[（47．4±11．3）岁vs．（62．7±11．0）岁]，男性比例较高（9：1vs4：1），农民及个体劳动者较多（70．0％vs．21．2％），差异均有统计学意义（P〈0．05）。梅毒组患者首发症状以头晕（35％）、头痛（20％）多见，记忆力减退（15％），行走不稳（15％）次之；粥样硬化组首发症状以肢体无力（75％）、言语不清（35％）多见。MRI检查中，梅毒组病灶以脑叶（45．0％）多见，多累及2个以上部位（70．0％）甚至3个以上部位（45．0％）。粥样硬化组多累及基底节（67．5％）。DSA检查中，梅毒性组大脑中动脉（65％）、颈内动脉（50．0％）狭窄多见，累及2条以上动脉（75．0%）甚至3条以上动脉（55．0％1多见，差异均有统计学意义（P〈0．05）。结论梅毒性脑动脉炎性脑梗死与动脉粥样硬化性脑梗死的临床表现及影像学表现各有特点，DSA在梅毒性脑动脉炎性脑梗死的诊断及治疗中有重要意义。Objective To search the clinical methods for identification cerebrovascular infarction from atherosclerotic cerebrovascular infarction. Methods of syphilis The clinical manifestations, laboratory examination results, MRI results and DSA characteristics of 20 patients with cerebrovascular infarction （syphilis group） and 80 patients with atherosclerotic cerebrovascular infarction （atherosclerosis group）, admitted to our hospital from February 2008 to August 2014, were retrospectively analyzed and compared. Results As compared with patients of the atherosclerosis group, the patients of syphilis group had significantly younger onset age （[47.4±11.3] y vs. [62.7±11.0]y）, higher male proportion （9：1 vs. 4：1）, higher proportion of farmers and individual workers （70 % vs. 21.2%, P〈0.05）. Dizziness （35%） and headache （20%） were more common as the first symptom, and memory loss （15%） and walking instability （15%） were more common as first symptoms in patients of syphilis group, while limb weakness （75%） and unclear speech （35%） were more common as first symptoms in patients of atherosclerosis group; significant differences were noted between the two groups （P〈0.05）. In MRI, lesions in lobes of the brain （45.0%） were more common in syphilis group, and lesions in the basal ganglia were （67.5%）more common in atherosclerosis group ; significant difference was noted between the two groups （P〈0.05）; lesions involved more than two sites （38.8%） or even three sites lesions （45.0%） were more common in patients of syphilis group. In DSA, middle cerebral artery stenosis （65%）, internalcarotid artery stenosis （38.8%） were more frequently found in patients of syphilis group, and more than two （75.0%） or even three （55.0%） vascular involvements were more common in syphilis group; significant difference was noted between the two groups （P〈0.05）. Conclusion The clinical features and imaging features of the syphilis cerebrovascular infarct

关 键 词：神经梅毒 动脉粥样硬化 脑梗死 数字减影血管造影 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R759.13[医药卫生—临床医学]