神经梅毒继发脑积水10例临床分析  

Clinical analysis of 10 cases of hydrocephalus secondary to neurosyphilis

作　　者：李东 刘洪军[2] 梁若飞 赵龙[2] 漆建[2] LI Dong;LIU Hongjun;LIANG Ruofei;ZHAO Long;QI Jian(Graduate School of North Sichuan Medical College,Nanchong 637000,Sichuan,China;Department of Neurosurgery,The Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China)

机构地区：[1]川北医学院研究生院,四川南充637000 [2]川北医学院附属医院神经外科,四川南充637000

出　　处：《西部医学》2023年第6期889-893,898,共6页Medical Journal of West China

基　　金：广东省重点领域研发计划*岭南中医药现代化专项课题(2020B1111100009)。

摘　　要：目的探讨神经梅毒继发脑积水患者的临床特征,为神经梅毒继发脑积水患者的诊断、治疗、预后提供理论依据。方法回顾性分析2019年11月—2022年3月川北医学院附属医院收治的35例神经梅毒患者的临床资料,其中10例患者继发脑积水,总结其临床表现、实验室检查、影像学检查的特点,并与常规神经梅毒患者的资料进行比较。结果神经梅毒继发脑积水患者中,男9例(90%),女1例(10%);年龄35~77岁,平均(57.50±14.52)岁;首发症状表现多样;脑积水组男性、年龄、全血超敏C反应蛋白、脑脊液TRUST显著高于非脑积水组(P<0.05);头颅磁共振表现多样;经正规治疗后,8例神经梅毒并脑积水患者行驱梅治疗后相应临床症状有不同程度缓解,1例患者驱梅后行脑室腹腔分流术(V-P)治疗脑积水三主征症状缓解,1例患者驱梅治疗无效。结论神经梅毒继发脑积水患者以中老年居多,男性多于女性,首发症状表现多样,MRI检查有助于临床诊断及分型,早期规范驱梅治疗可有效改善患者预后,驱梅治疗后脑积水症状未缓解行V-P术可改善患者临床症状。Objective To explore the clinical characteristics of patients with hydrocephalus secondary to neurosyphilis,and provide theoretical basis for the diagnosis,treatment and prognosis of patients with neurosyphilis secondary to hydrocephalus.Methods The clinical data of 35 patients with neurosyphilis admitted to The Affiliated Hospital of North Sichuan Medical College from November 2019 to March 2022 were retrospectively analyzed,of which 10 patients had secondary hydrocephalus,and their clinical manifestations,laboratory tests,and imaging tests were summarized.and compared with the data of conventional neurosyphilis patients.Results Among the patients with hydrocephalus secondary to neurosyphilis,there were 9 males(90%)and 1 female(10%),the age ranged from 35 to 77 years old,with an average age of 57.50±14.52 years old.The first symptoms were diverse.Male,age,whole blood high-sensitivity C-reactive protein,cerebrospinal fluid TRUST in the hydrocephalus group were significantly higher than those in the non-hydrocephalus group(P<0.05).Head MRI results were diverse.After regular treatment,the corresponding clinical symptoms of 8 patients with neurosyphilis complicated with hydrocephalus were relieved to varying degrees after anti-syphilis treatment,and 1 case The symptoms of the three main symptoms of hydrocephalus were relieved by VP surgery after expelling plum,and 1 patient was ineffective in expelling plum.Conclusion The majority of patients with neurosyphilis secondary to hydrocephalus are middle-aged and elderly patients,males are more than females,and the initial symptoms are diverse.MRI examination is helpful for clinical diagnosis and classification.Early standardized antisyphilis treatment can effectively improve the prognosis of patients.V-P surgery can improve the clinical symptoms of patients who have not relieved the symptoms of hydrops.

关 键 词：神经梅毒 脑积水 临床分析 影像学特点 

分 类 号：R741[医药卫生—神经病学与精神病学]