以认知功能障碍及精神行为异常起病的神经梅毒治疗前后实验室指标的变化分析  

Analysis of Laboratory Index before and after Neurosyphilis Treatment with cognitive dysfunction and abnormal mental behavior

作　　者：张磊[1] 高俊华 李务荣 许东梅 ZHANG Lei;GAO Junhua;LI Wurong;XU Dongmei(Beijing Ditan Hospital Affiliated to Capital Medical University,Beijing 100015 China)

机构地区：[1]首都医科大学附属北京地坛医院,北京100015

出　　处：《中国实用神经疾病杂志》2022年第6期729-735,共7页Chinese Journal of Practical Nervous Diseases

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”项目(编号:DTQH201607)。

摘　　要：目的分析以认知功能障碍及精神行为异常起病的神经梅毒患者治疗前后实验室指标的变化,探讨评价疗效的方法。方法选取2015-01—2020-03首都医科大学附属北京地坛医院神经内科确诊的70例以认知功能障碍及精神行为异常起病神经梅毒患者,记录血TRUST滴度、脑脊液TRUST滴度、脑脊液常规白细胞计数、脑脊液蛋白质定量及梅毒脑脊液检验指标分级评定的基线及随访结果,对比分析经过青霉素规范驱梅治疗前后上述指标的变化。结果70例患者中,男57例,女13例,年龄(50.54±11.30)岁。共计66例完成了第一次随访,53例完成了第二次随访,34例完成了第三次随访,14例完成了第4次随访。对各种指标在治疗后不同时间截点的构成比进行比较,脑脊液TRUST差异有统计学意义(χ^(2)=21.342,P<0.001),脑脊液白细胞计数差异无统计学意义(χ^(2)=8.605,P=0.072),脑脊液蛋白含量差异有统计学意义(χ^(2)=13.573,P<0.001),梅毒脑脊液检验指标分级差异有统计学意义(χ^(2)=37.247,P<0.001)。对血TRUST、脑脊液TRUST、脑脊液白细胞计数、脑脊液蛋白含量及梅毒脑脊液检验指标分级情况进行两两之间的相关性分析。在P=0.01级别上,脑脊液蛋白含量和血TRUST之间相关性不显著(r=0.116),其余指标两两之间均显著相关,其中梅毒脑脊液检验指标分级与脑脊液TRUST之间r=0.820,与脑脊液白细胞计数之间r=0.659,血TRUST与脑脊液TRUST之间r=0.593。结论规范青霉素治疗仅对部分以认知功能障碍及精神行为异常起病的神经梅毒患者有效,各项脑脊液检测指标对疗效评价有差异,而使用脑脊液实验室指标分级评价此类患者治疗效果可能是一种简便的方法。Objective Analyze the changes of laboratory indicators before and after the treatment of neurosyphilis patients with cognitive dysfunction and abnormal mental behavior,and explore the method to evaluate the efficacy.Methods Between January 2015 and March 2020,we recorded blood TRUST titer,CSF TRUST titer,CSF routine WBC count,CSF protein quantification and Classification and evaluation of syphilis CSF test index baseline and follow-up results,and analyzed the changes before and after penicillin standard plum treatment.Results Of 70 patients,57 males and 13 females,with a mean age of(50.54±11.30)years.A total of 66 people completed the first follow-up,53 completed the second,34 completed the third,and 14 completed the fourth follow-up.Comparison of the composition ratios of various measures at different times after treatment,CSF TRUST,χ^(2)=21.342,P<0.001 suggesting significant differences.For the CSF leukocyte count,theχ^(2)=8.605P value was equal to 0.072,suggesting that the differential significance was not significant.CSF protein content,χ^(2)=13.573,P<0.001,suggests a significant difference.Grading of syphilis CSF test index,χ^(2)=37.247,P<0.001,suggesting a significant difference.Correlation between pairwise analysis of blood TRUST,CSF TRUST,CSF WBC count,CSF protein content and grading of syphilis CSF test index.At P=level 0.01,r=0.116 between CSF protein content and blood TRUST,the correlation was not significant.The remaining indicators showed significant correlation between pairwise,with r=0.820 between syphilis CSF test index grade and CSF TRUST,0.659 between CSF WBC count,and 0.593 between blood and CSF TRUST.Conclusion Regulating penicillin treatment is only effective in some neurosyphilis patients with cognitive dysfunction and abnormal mental behavior.CSF testing indicators differ in efficacy evaluation,and using CSF laboratory indicators for grading evaluation of such patients may be a simple method.

关 键 词：神经梅毒 认知功能障碍 精神行为异常 脑脊液 实验室检查 

分 类 号：R749.2[医药卫生—神经病学与精神病学]