麻痹性痴呆型与无症状型神经梅毒的临床及影像学特征分析  

Analysis of clinical and imaging features of GPI and asymptomatic neurosyphilis

作　　者：邢玉雪 李晶晶 杜艳妮 谢汝明 陈步东 XING Yuxue;LI Jingjing;DU Yanni;XIE Ruming;CHEN Budong(Department of Radiology,Beijing Ditan Hospital,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放射科,北京100015

出　　处：《医学影像学杂志》2023年第3期361-365,共5页Journal of Medical Imaging

摘　　要：目的探讨麻痹性痴呆型(GPI)与无症状型神经梅毒患者的临床及影像学特征。方法选取30例GPI患者(GPI组)及24例无症状型神经梅毒患者(无症状型NS组),对比两组的临床各项生化指标及影像学特征,分析患者的脑萎缩程度与临床生化指标是否具有相关性,应用ROC曲线分析脑萎缩程度预测无症状转GPI的灵敏度、特异度。结果1)30例GPI、24例无症状型两组患者中血清TRUST滴度差异无统计学意义(P>0.05),而脑脊液中TRUST滴度差异有统计学意义(P=0.010)。两组患者的MMSE评分差异具有统计学意义(P=0.011);2)影像学方面,两组患者的颞叶信号差异有统计学意义(左侧颞叶P=0.028,右侧颞叶P=0.002);两组患者的颞叶萎缩程度差异有统计学意义(P<0.001);3)应用ROC曲线,AUC为0.955(95%CI=0.906~1.0,P<0.001),界值为2.5时,无症状型向GPI发展的可能性较高,其诊断敏感度为75.6%、特异度为76.2%;4)颞叶萎缩程度与MMSE评分具有一定的相关性(r=-0.526,P=0.002),与血液及脑脊液的生化指标的相关性差异无统计学意义(P>0.05)。结论GPI与无症状型神经梅毒患者常常出现不符合年龄的脑萎缩改变,若颞叶萎缩程度超过2级时要警惕无症状型向GPI的发展;另一方面,GPI多于T 2WI及FLAIR上双侧或单侧颞叶存在异常高信号改变。Objective To investigate the clinical and imaging features of patients with paralytic dementia(GPI)and asymptomatic neurosyphilis.Methods The clinical and imaging data of 30 patients with GPI and 24 patients with asymptomatic neurosyphilis were retrospectively analyzed.The correlation between the degree of brain atrophy and the clinical biochemical indexes was analyzed.The sensitivity and specificity of predicting asymptomatic to GPI with the degree of brain atrophy were analyzed with ROC curve.Results 1)There was no significant difference in serum TRUST titer between 30 GPI patients and 24 asymptomatic patients(P>0.05),however,there was significant difference in CSF TRUST titer(P=0.010).The difference of MMSE scores between the two groups was statistically significant(P=0.011);2)On imaging,the temporal lobe signal difference between the two groups was statistically significant(left temporal lobe P=0.028,right temporal lobe P=0.002);The difference of temporal lobe atrophy between the two groups was statistically significant(P<0.001);3)Using ROC curve,AUC was 0.955(95%CI=0.906~1.0,P<0.001),and the cut-off value was 2.5.The possibility of asymptomatic dementia was higher,and its diagnostic sensitivity was 75.6%,specificity was 76.2%;and 4)There was a certain correlation between the degree of temporal lobe atrophy and the MMSE score(r=-0.526,P=0.002),but there was no significant correlation between the degree of temporal lobe atrophy and the biochemical indexes of blood and cerebrospinal fluid(P>0.05).Conclusion Patients with GPI and asymptomatic neurosyphilis often have brain atrophy changes that do not match the age.If the degree of temporal lobe atrophy exceeds grade 2,the development of asymptomatic to GPI should be alerted;on the other hand,GPI is more frequent than that has high signal changes in bilateral or unilateral temporal lobe on T 2WI and FLAIR.

关 键 词：神经梅毒 麻痹性痴呆 颞叶 磁共振成像 

分 类 号：R759.1[医药卫生—皮肤病学与性病学] R445.2[医药卫生—临床医学]