21例神经梅毒患者异常图形翻转视觉诱发电位分析  

Analysis of abnormal patterns reversal visual evoked potential(P-VEP)in 21 patients with neurosyphilis

作　　者：闫超玲 伍文清 王素梅 徐丹 孙鑫婕 许东梅 Yan Chaoling;Wu Wenqing;Wang Sumei;Xu Dan;Sun Xinjie;Xu Dongmei(Department of Neurology,Beijing Ditan Hospital,Capital Medical University;Beijing Key Laboratory of Emerging Infectious Diseases,Beijing 10015,China)

机构地区：[1]首都医科大学附属北京地坛医院神经内科,北京100015 [2]新发突发传染病研究北京市重点实验室

出　　处：《中华实验和临床感染病杂志（电子版）》2020年第3期212-217,共6页Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)

基　　金：首都医科大学附属北京地坛医院院内科研基金“启航计划”(No.DTQH201607)。

摘　　要：目的探讨图形翻转视觉诱发电位(P-VEP)在神经梅毒所致视神经损伤患者的早期诊断及病情评估中的应用价值。方法收集2016年1月至2019年12月于首都医科大学附属北京地坛医院完善P-VEP检查且P100波潜伏期异常的21例神经梅毒患者,分析其P-VEP结果、临床表现、脑脊液及血清指标的特点。结果21例P-VEP异常的神经梅毒患者中以男性患者多见(76%、16/21),平均年龄为(45.0±11.5)岁。17例患者眼部症状阳性,4例患者眼部症状阴性。17例眼部症状阳性的患者均被诊断为视神经炎。P-VEP异常主要表现为P100波潜伏期延长或P100波缺失。患眼P100波潜伏期(135.16±22.21)ms较正常眼潜伏期(92.75±8.26)ms显著延长,差异有统计学意义(t=-2.813、P=0.007)。眼部症状阳性的神经梅毒患者较症状阴性患者的P100波潜伏期更长[(137.94±23.12)ms vs.(120.33±5.50)ms],差异有统计学意义(t=1.28、P=0.217)。P100波潜伏期和脑脊液白细胞(r=0.349、P=0.155)及蛋白(r=0.240、P=0.323)间无显著相关性。追踪分析8例治疗后复查患者的临床资料,发现治疗前后P100波潜伏期变化与血清及脑脊液常规、生化指标间无显著相关性(P均>0.05)。有5只患眼表现为P100波缺失,其在治疗后6个月内P100波仍缺失。结论神经梅毒患者P-VEP检查P100波潜伏期延长或波形缺失提示视神经损害;P100波波形缺失可能提示视神经损伤较为严重或不可逆转;在神经梅毒患者未出现视神经受损症状前即可通过检查P-VEP发现视神经受损,为明确神经梅毒患者是否存在视神经损伤及损伤程度提供一定依据。Objective To investigate the clinical value of pattern reversal visual evoked potential(P-VEP)in early diagnosis and assessment of optic nerve injury caused by neurosyphilis.Methods Total of 21 neurosyphilis patients with abnormal P100 wave latency and with P-VEP examination in Beijing Ditan Hospital,Capital Medical University from January 2016 to December 2019 were collected and the P-VEP results,clinical manifestations,characteristics of cerebrospinal fluid and serum indicators were analyzed,respectively.Results Among the 21 patients with abnormal P-VEP,most were male(76%,16/21).The mean age was(45.0±11.5)years old.There were 17 patients with positive ocular symptoms and 4 patients with negative ocular symptoms.All patients with abnormal P-VEP neurosyphilis had optic nerve damage,whether symptomatic or asymptomatic.The abnormality of P-VEP was mainly manifested as prolonged latency of P100 wave.Of the abnormal eyes of P100 latency[(135.16±22.21)ms]was significantly longer than that of normal eyes[(92.75±8.26)ms],with significant difference(t=-2.813,P=0.007).Patients with positive ocular symptoms had a longer latency of P100 wave[(137.94±23.12)ms]than patients without ocular symptoms[(120.33±5.50)ms],with significant difference(t=1.28,P=0.217).There was no correlation between P100 wave latency and white blood cells(r=0.349,P=0.155)and protein(r=0.240,P=0.323)of cerebrospinal fluid.The clinical data of 8 reexamined patients were analyzed and the changes of P100 wave latency were not consistent with the biochemical manifestations of serum and cerebrospinal fluid(all P>0.05).Five of the eyes presented P100 wave absence,which did not improve during 6 months after treatment.P100 wave deletion may indicate that the optic nerve damage was irreversible.Conclusions Prolonged latency of P100 wave or absence of waveforms in patients with neurosyphilis may indicate optic nerve damage.The absence of a P100 wave form may indicate severe and irreversible optic nerve damage.Abnormal P-VEP may indicate neurosyphilis optic n

关 键 词：神经梅毒 视神经 图形翻转视觉诱发电位 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]