神经梅毒104例临床分析  

Clinical analysis of 104 cases of neurosyphilis

作　　者：段贤 周珍[2] 孙启英[1] 李雯雯 黄娟[1] 许宏伟[1] 周琳[1] DUAN Xian;ZHOU Zhen;SUN Qi-ying;LI Wen-wen;HUANG Juan;XU Hong-wei;ZHOU Lin(Department of Geriatrics,Xiangya Hospital of Centred South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院老年病科,湖南长沙410008 [2]南华大学附属湖南省儿童医院神经内科,湖南长沙410007 [3]湘雅常德医院神经内科,湖南常德415003

出　　处：《临床皮肤科杂志》2020年第7期409-413,共5页Journal of Clinical Dermatology

基　　金：湖南省重点研发计划(2016JC2060)资助项目。

摘　　要：目的:进一步了解神经梅毒(neurosyphilis,NS)的临床特征。方法:对中南大学湘雅医院2010年5月至2018年5月收治入院的104例NS患者(NS组)及42例已行脑脊液(CSF)检查阴性的血清梅毒患者(对照组)的临床资料进行回顾性分析。结果:共收集104例临床确诊为NS的患者,男71例,女33例,平均发病年龄(47.3±11.4)岁;其中无症状型患者12例,脑膜炎型患者18例,脑血管型患者28例,树胶样肿型患者5例,脊髓痨型患者16例,麻痹性痴呆型患者25例。无症状型NS组的平均年龄、CSF总蛋白浓度及CSF快速血浆反应素试验(RPR)滴度均低于症状型NS组(P<0.05);42例血清梅毒组患者,平均年龄(34.6±11.4)岁,其平均年龄、CSF白细胞计数、CSF总蛋白浓度、血清RPR滴度及CSF-RPR滴度均低于NS组(P<0.05);无症状型NS组、间质型NS组和实质型NS组患者之间的平均年龄、CSF总蛋白浓度及CSF-RPR滴度的差异均有统计学意义(P<0.05)。77例NS患者经规范驱梅治疗后症状均有不同程度好转。结论:NS临床表现复杂多样,实验室检查及影像学检查结果各异。在中枢神经系统疾病中应注意NS的鉴别诊断。NS的早期诊断对于及时规范的治疗非常重要。Objective: To further understand the characteristics of neurosyphilis(NS). Methods: The clinical data of 104 patients with NS and 42 patients with syphilis who had negative results of cerebrospinal fluid(CSF) test, admitted to Xiangya Hospital Central South University from May 2010 to May 2018, were retrospectively analyzed. Results: A total of 104 pa tients with clinically diagnosed NS were enrolled, including 71 males and 33 females with an average age of onset of 47.3±11.4 years. Among them, 12 cases were asymptomatic NS, 18 cases were meningitis NS, 28 cases were cerebrovascular NS, 5 cases were gelatinous NS, 16 cases were spinal cord sputum NS, and 25 cases were paralytic dementia NS. The age, CSF protein concentration and CSF-RPR titer of patients in the asymptomatic NS group were lower than those in the symptomatic NS group(P<0.05). The 42 syphilis patients with negative CSF(Non-NS, control group) had an average age of 34.6±11.4 years. The age, CSF white blood cell count, CSF protein concentration, serum RPR titer and CSF-RPR titer of those 42 non-NS patients were lower than those in the NS group(P<0.05). There were statistical significant differences in the age and CSF protein concentration between asymptomatic NS, interstitial NS and parenchymal NS groups(P<0.05). Seventy-seven patients with NS had varying degrees of response and improvement after standardized treatment. Conclusion: The clinical manifestations of NS are complex and diverse. The results of laboratory examinations and imaging examinations can be variable. NS should be considered in the differential diagnosis of the central nervous system diseases to avoid missed diagnosis and misdiagnosis. Early diagnosis is important to ensure a prompt and standardized treatment of patients with NS.

关 键 词：神经梅毒 临床表现 脑脊液特征 影像学特征 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]