神经梅毒37例临床分析

Neurosyphilis in 37 cases

目的 探讨神经梅毒患者的临床表现、实验室检查、影像学特征、诊断、治疗及预后.方法 对我院2000年至2009年诊治的37例神经梅毒患者的临床资料进行回顾性分析.结果 本组37例患者中,脑血管型神经梅毒16例,麻痹性痴呆13例,脊髓梅毒3例,脑膜型神经梅毒2例,无症状神经梅毒2例,树胶肿型神经梅毒1例.血清快速血浆反应素(RPR)试验、梅毒螺旋体血凝试验(TPHA)试验均阳性.脑脊液(CSF)的RPR试验阳性率为67.6%,TPHA试验阳性率为100%;脑脊液检查蛋白增高阳性率为64.9%,细胞数增高阳性率为54.1%.结论 神经梅毒患者的临床表现复杂,诊断应结合临床表现、实验室及影像学检查综合分析,脑脊液检查是关键,应争取早期诊断、早期治疗以改善预后.同时应从公共卫生的的理念上去规划和实施梅毒的预防和治疗,以降低神经梅毒的发病率。

Objective To investigate the clinical manifestations, laboratory tests, imaging features,diagnosis, treatment and prognosis of neurosyphilis.Methods The 37 cases of patients with neurosyphilis admitted in our hospital from 2000 to 2009 were analyzed retrospectively.Results Among the 37cases, the cerebral vascular neurosyphilis in 16 cases, paralytic dementia in 13 cases, spinal cord syphilis in 3 cases, meningeal neural syphilis in 2 cases, asymptomatic neurosyphilis in 2 cases, gumma type in 1case.Serum rapid plasma reagin(RPR)test and treponema pallidum hemagglutination assay(TPHA)test were all positive.the positive rate of cerebrospinal fluid(CSF)the RPR was 67.6%, the TPHA was 100% ,the cerebrospinal fluid examination revealed CSF protein increase was 64.9% and cell number elevation was 54.1%.Conclusions Because of theclinical manifestations of neurosyphilis are complex, the diagnosis should be comprehensive analysis, according to the clinical characteristics, laboratory and imaging features,the cerebrospinal fluid examination is the key.It is should be strived for early diagnosis and treatment to improve prognosis.At the same time, in order to reduce the incidence of neurosyphilis, there should go up to plan and enforce the prevention and treatment of syphilis from the concept of public health.