131例神经梅毒患者临床特征及实验室检查结果分析  

Analysis of clinical characteristics and laboratory findings of 131 cases of neurosyphilis

作　　者：汤华阳[1] 高金平[1] 郭泽 魏瑾 樊娇娇 唐先发[1] 王培光[1] 孔晓明[3] 杨森[1] Tang Huayang;Gao Jinping;Guo Ze;Wei Jin;Fan Jiaojiao;Tang Xianfa;Wang Peiguang;Kong Xiaoming;Yang Sen(Department of Dermatology and Venereology,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Dermatology and Venereology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015.China;Department of Geriatric Psychology,Affiliated Psychological Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院皮肤性病科,合肥230022 [2]首都医科大学附属北京地坛医院皮肤性病科,100015 [3]安徽医科大学附属心理医院老年心理科,合肥230022

出　　处：《中华皮肤科杂志》2020年第10期774-780,共7页Chinese Journal of Dermatology

基　　金：国家自然科学基金(81573061)。

摘　　要：目的深入了解神经梅毒在男女性之间以及有无神经症状患者之间的特征差异,为神经梅毒的防控、临床诊断与治疗提供依据。方法回顾分析2015年6月至2019年12月安徽医科大学第一附属医院皮肤性病科131例神经梅毒住院患者的临床表现和实验室检查结果,根据性别以及神经/精神症状分组。组间比较采用独立双样本t检验或Mann?Whitney U检验,分类变量计数资料采用χ2检验和Fisher精确检验,比较不同组别之间临床特征及实验室指标差异。结果131例患者中,无症状神经梅毒72例(无症状组),有症状神经梅毒59例(有症状组)。有症状组的既往驱梅治疗比例(10.17%)显著低于无症状组(98.61%)(OR=0.002,P<0.001)。男性患者和有症状患者的首诊误诊率分别为50.00%和89.83%,分别高于女性患者(24.49%,OR=3.08,P=0.004)和无症状患者(0,OR=13.00,P<0.001)。男性有症状患者比例(57.32%)显著高于女性患者(14.64%)(OR=4.14,P=0.003),脑脊液甲苯胺红不加热血清试验(TRUST)阳性率(52.44%)显著高于女性患者(26.54%)(OR=3.05,P=0.004),脑脊液总蛋白含量升高(>0.5 g/L)者的比例(79.27%)高于女性(59.18%)(OR=2.64,P=0.01),脑脊液总蛋白含量[(0.76±0.41)g/L]高于女性[(0.56±0.25)g/L,P=0.002],并且男性脑部核磁共振成像异常检出率(72.22%)高于女性(44.90%)(OR=2.13,P=0.039)。有症状女性患者的确诊年龄[(50.82±9.31)岁]大于无症状女性患者[(42.30±12.18)岁](P?=?0.038)。有症状神经梅毒患者脑脊液TRUST阳性率(55.93%)高于无症状患者(31.94%)(OR=2.70,P=0.006),脑脊液总蛋白水平[(0.79±0.46)g/L]显著高于无症状患者[(0.60±0.24)g/L,P=0.003]。结论神经梅毒首诊误诊率高;男性患者病情较女性患者严重;既往驱梅治疗史、性别和年龄因素在神经梅毒病程发展过程中可能起一定作用。Objective To deeply analyze differences in characteristics of neurosyphilis between male and female patients with neurosyphilis,as well as between patients with symptomatic neurosyphilis and those with asymptomatic neurosyphilis,and to provide reference for the prevention and control,clinical diagnosis and treatment of neurosyphilis.Methods A total of 131 inpatients with neurosyphilis were collected from Department of Dermatology and Venereology,the First Affiliated Hospital of Anhui Medical University from June 2015 to December 2019,and their clinical manifestations and laboratory findings were retrospectively analyzed.These patients were grouped according to gender and neurological/psychiatric symptoms.Measurement data were compared by using two-independent-sample t test or Mann-Whitney U test,and enumeration data were compared by using chi-square test and Fisher′s exact test,to analyze differences in clinical characteristics and laboratory indicators between different groups.Results Among the 131 patients,there were 72 with asymptomatic neurosyphilis(asymptomatic group)and 59 with symptomatic neurosyphilis(symptomatic group).The proportion of patients receiving syphilis treatment was significantly lower in the symptomatic group(10.17%)than in the asymptomatic group(98.61%,OR=0.002,P<0.001).The misdiagnosis rate at the first clinical visit was significantly higher in the male patients(50.00%)than in the female patients(24.49%,OR=3.08,P=0.004),as well as in the symptomatic patients(89.83%)than in the asymptomatic patients(0,OR=13.00,P<0.001).The proportion of symptomatic patients was significantly higher in male patients(57.32%)than in female patients(14.64%,OR=4.14,P=0.003).Compared with the female patients,the male patients showed significantly increased positive rates of toluidine red unheated serum test(TRUST)in the cerebrospinal fluid samples(52.44%vs.26.54%,OR=3.05,P=0.004),increased proportions of patients with elevated levels of total protein(>0.5 g/L)in cerebrospinal fluids(79.27%vs.59.18%,OR=2.64,P=0

关 键 词：神经梅毒 脑脊髓液 白细胞增多 性别因素 年龄因素 梅毒血清诊断 磁共振成像 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]