20例HIV抗体阴性神经梅毒患者的临床分析

Clinical analysis of 20 HIV-negative patients with neurosyphilis

目的总结神经梅毒的临床特征以提高对其疾病的认识。方法回顾性分析了20例艾滋病病毒(HIV)抗体阴性的神经梅毒患者的临床表现、实验室检查和影像学特点。结果20例神经梅毒患者中,无症状神经梅毒2例,间质型神经梅毒9例,实质型神经梅毒8例(麻痹性痴呆5例和脊髓痨3例),特殊类型神经梅毒(多颅神经损害)1例。实验室检查示,63.16%的患者脑脊液快速血浆反应素试验(CSF-RPR)阳性,100%的梅毒螺旋体抗原凝集试验(CSF-TPPA)阳性,脑脊液蛋白和细胞数增高分别为75%和50%;头颅CT和MRI表现脑萎缩、梗死或脱髓鞘病变。结论神经梅毒的临床表现与其分型密切相关,实质型神经梅毒应引起重视;TPPA或许在神经梅毒脑脊液检测中可以使用,但神经梅毒的诊断应结合临床表现及辅助实验检查综合分析。

Objective To study the clinical features of 20 HIV-negative patients with neurosyphilis so as to provide evidences of early diagnosis. Methods Clinical feature, laboratory findings and neuroimages of 20 cases of neurosyphilis were analyzed retrospectively. Results In all cases, 2 patients were asymptomatic, 9 had mesenchymal, 8 had parenchymal （5 with general paralysis and 3 with tabes dorsalis）and 1 had＂atypical neurosyphilis＂ （multi- cranial nerve damdge） ; 63.16 96 of patients were reactive to rapid plasma reagent test（RPR）and 100 96 of patients were reactive to treponema pallidum particle assay（TPPA）of the cerebrospinal fluid. The cerebrospinal fluid protein increased in 75 % of the patients,and cells increased in 50 % of them. Changes of cerebral atrophy,infarction and demyelination were found on the CT and MRI of cranium. Conclusion The clinical manifestations of neurosyphilis are closely related to pathological types. Serious attention should be paid to parenchymal neurosyphilis. It seems that the TPPA can be used in CSF to diagnose neurosyphilis. The diagnosis of neurosyphilis should be made according to the combination of clinical manifestations and other laboratory tests.