85例神经梅毒临床、实验室和头颅MRI特征研究  

Clinical,laboratory,and brain MRI characteristics of 85 patients with neurosyphilis

作　　者：谢彩蝶 徐寿成 郑亚彬 XIE Caidie;XU Shoucheng;ZHENG Yabin(Department of General Medicine,the Second Hospital of Nanjing,Affiliated to Nanjing Unitersity of Chinese Medicine,Nanjing 210003,China)

机构地区：[1]南京中医药大学附属南京医院(南京市第二医院)综合内科,210003 [2]南京中医药大学附属南京医院(南京市第二医院)神经内科,210003 [3]镇江市第一人民医院神经内科

出　　处：《临床神经病学杂志》2023年第6期457-461,共5页Journal of Clinical Neurology

摘　　要：目的分析神经梅毒(NS)患者临床、实验室和头颅MRI的特征表现。方法回顾性分析2018年11月至2022年11月入住南京市第二医院神经内科85例NS患者的临床资料。根据头颅MRI结果,将患者分为MRI正常+单侧病变组及双侧病变组(较重型)。通过绘制ROC曲线及计算曲线下面积(AUC)评价临床指标对MRI较重型NS的诊断价值。结果与MRI正常+单侧病变组相比,双侧病变组平均年龄明显升高(P=0.000)、男性(P=0.008)以及有神经或精神症状(P=0.006)占比明显增多;超敏C反应蛋白(P=0.028)、嗜碱性粒细胞(P=0.003)、纤维蛋白原(P=0.011)、CSF甲苯胺红不加热血清试验滴度(P=0.004)、CSF蛋白浓度(P=0.000)、CSF腺苷脱氨酶(P=0.003)、CSF白细胞计数(P=0.049)明显增高。多因素回归分析显示,年龄(OR=1.085,P=0.019)和CSF蛋白浓度(OR=1.004,P=0.023)是头颅MRI较重型NS的危险因素。使用年龄、CSF蛋白浓度、嗜碱性粒细胞构建临床模型预测头颅MRI较重型NS发生的AUC可达0.83(95%CI:0.73~0.91,P<0.01)。结论NS的诊治应综合临床、实验室及头颅MRI检查,年长及CSF蛋白浓度高的患者提示病情偏重,降低CSF蛋白浓度有望改善NS患者病情。Objective To analyze the clinical,laboratory and brain MRI features of patients with neurosyphilis(NS).Methods Eighty-five NS patients admitted to the Department of Neurology in Nanjing Second Hospital from November 2018 to November 2022 were retrospectively analyzed.According to the results of brain MRI,the patients were divided into two groups:normal brain MRI+unilateral lesions group and bilateral lesions group(more severe group).ROC were plotted and the areas under the curves(AUC)were calculated to evaluate the diagnostic value of clinical indicators for severe NS on MRI.Results Compared with normal brain MRI+unilateral lesions group,the mean age(P=0.000),the rate of male(P=0.008)and the rate of symptomatic NS(P=0.006)were significantly higher in bilateral lesions group.Moreover,hypersensitive C-reactive protein(P=0.028),basophil(P=0.003),fibrinogen(P=0.011),CSF tolulized red unheated serum test titer(P=0.004),CSF protein concentration(P=0.000),CSF adenosine deaminase(P=0.003),and CSF white blood cell count(P=0.049)were significantly increased in patients with NS in bilateral brain lesions group.Multivariate regression analysis suggested that age(OR=1.085,P=0.019)and CSF protein concentration(OR=1.004,P=0.023)were risk factors for NS patients with bilateral brain lesions on MRI.The clinical model was established by age,CSF protein concentration,and basophil,the AUC for predicting NS patients with bilateral brain lesions could reach 0.83(95%CI:0.73-0.91,P<0.01).Conclusions Clinical,laboratory and brain MRI examination should be integrated during the diagnosis and treatment of NS.Elderly patients and patients with high CSF protein concentration suggest severe disease,and reduction of CSF protein concentration is expected to improve the condition of NS patients.

关 键 词：神经梅毒 MRI CSF LOGISTIC回归模型 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]