神经梅毒患者临床特征及影响日常生活能力因素分析  

Analysis of clinical characteristics and factors affecting activities of daily living in patients with neurosyphilis

作　　者：谢彩蝶 徐寿成 张宁[1] 王蔚[3] 何珊珊 郑亚彬 XIE Caidie;XU Shoucheng;ZHANG Ning;WANG Wei;HE Shanshan;ZHENG Yabin(Department of General Internal Medicine,The Second Hospital of Nanjing,Nanjing Hospital Affiliated to Nanjing University 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,南京210003 [2]镇江市第一人民医院神经内科 [3]南京中医药大学附属南京医院(南京市第二医院)神经内科

出　　处：《中国神经精神疾病杂志》2025年第3期135-141,共7页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的分析神经梅毒(neurosyphilis,NS)患者的临床资料,探讨影响其日常生活活动能力(activity of daily living,ADL)的因素。方法对90例NS患者的临床资料进行回顾性分析,使用巴塞尔指数(Barthel index,BI)评估患者入院时ADL,将患者分为无需依赖组、轻度依赖组和中重度依赖组,通过比较分析和多因素线性回归分析,探讨ADL的影响因素。采用受试者操作特征(receiver operating characteristic,ROC)曲线评估临床指标对出院时ADL恢复不良(BI评分≤60分)患者的预测效能。结果90例NS患者,年龄(54.17±12.45)岁,男性70例(77.78%)。临床表现中精神行为异常(44.44%)最为常见,其次为肢体感觉或运动障碍(25.56%)、构音障碍(16.67%)。根据BI评分分组,无需依赖组41例(45.6%),轻度依赖组31例(34.4%),中重度依赖组18例(20.0%)。3组比较,中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)逐渐增高[2.80(1.97,4.73)vs.3.80(2.28,4.89)vs.5.37(3.76,7.20)],中重度依赖组分别高于无需依赖组及轻度依赖组(P<0.05);脑脊液蛋白浓度逐渐增多[427(341,644)mg/L vs.553(425,830)mg/L vs.933(641,1706.5)mg/L],两两比较均有统计学差异(P<0.05)。多因素线性回归分析显示,NLR(β=-0.242,P=0.018)和脑脊液蛋白浓度(β=-0.461,P<0.001)与入院时的ADL呈负相关。脑脊液蛋白浓度预测出院时ADL恢复不良患者的曲线下面积(area under the curve,AUC)为0.806(95%CI:0.708~0.883,P<0.001),最佳截断值为620 mg/L,敏感性和特异性分别为86.7%和69.4%。结论NS患者主要临床表现为精神行为异常,NLR、脑脊液蛋白浓度增高与ADL降低相关联,早期积极干预炎症反应及脑脊液蛋白异常可能为改善患者预后提供新思路。Objective To analyze the clinical data of patients with neurosyphilis(NS)and explore factors influencing their activity of daily living(ADL).Methods The clinical data of 90 patients with NS was retrospectively analyzed,and the ADL scores at admission were assessed by using the Barthel index(BI).The patients were divided into no-dependency,mild-dependency,and moderate-to-severe-dependency groups.The influencing factors of ADL were explored through comparative analysis and multiple linear regression analysis.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of clinical indicators for poor ADL recovery(BI score≤60)at discharge in patients.Results Among the 90 NS patients,the average age was 54.17±12.45 years,with 70 males(77.78%).The most common clinical manifestation was abnormal mental behavior(44.44%),followed by limb sensory or motor disorders(25.56%)and dysarthria(16.67%).Based on the BI scores,41 patients(45.6%)were independent,31 patients(34.4%)had mild dependence,and 18 patients(20.0%)had moderate to severe dependence.The comparison results of the three groups showed that the neutrophil-to-lymphocyte ratio(NLR)was gradually increased[2.80(1.97,4.73)vs.3.80(2.28,4.89)vs.5.37(3.76,7.20)]which was higher in the moderate-to-severe-dependency group than in the independent and the mildlydependent group(P<0.05);cerebrospinal fluid protein concentration[427(341,644)mg/L vs.553(425,830)mg/L vs.933(641,1706.5)mg/L]was gradually increased and there were significant differences in pairwise comparisons(P<0.05).Multiple linear regression analysis showed that NLR(β=-0.242,P=0.018)and cerebrospinal fluid protein concentration(β=-0.461,P<0.001)were negatively correlated with ADL at admission.The area under curve(AUC)for cerebrospinal fluid protein concentration in predicting poor ADL recovery at discharge was 0.806(95%CI:0.708-0.883,P<0.001),with an optimal cutoff value of 620 mg/L,sensitivity of 86.7%,and specificity of 69.4%.Conclusion The main clinical manifestations of NS pati

关 键 词：神经梅毒 精神行为异常 日常生活能力 巴塞尔指数 脑脊液 炎症 回归分析 

分 类 号：R749[医药卫生—神经病学与精神病学] R759.13[医药卫生—临床医学]