获得性梅毒的眼后节表现及治疗预后

Manifestations and treatment outcomes of acquired ocular posterior segment syphilis

目的观察首诊于眼科以眼后节表现为主的眼部梅毒的临床特点及治疗预后。方法回顾分析24例就诊于本院眼科，由眼科首先诊断为梅毒，并经梅毒螺旋体颗粒凝集试验（TPPA）和快速血浆反应素试验（RPR）检查证实为活动性眼部梅毒患者的临床资料。其中，男性17例，女性7例。年龄30至63岁，平均年龄为47．6岁。病程3d至2年。平均病程5．8个月。病程小于等于1个月者7例，1至3个月者5例，3至6个月者5例，病程大于6个月者7例。双眼发病18例，单眼发病6例。HIV检查均为阴性。除1例青霉素过敏患者采用口服红霉素治疗以外，均行全身青霉素治疗。治疗前平均视力为0．17±0．19，平均RPR滴度为1：84。治疗后随访半年，观察患眼视力和炎症消退情况。结果24例患者中，眼部表现为脉络膜视网膜炎者17例，其中1例为单眼发病；视网膜血管炎和视神经视网膜炎者各2例，均为单眼发病；视神经炎3例，1例为单眼发病。治疗后半年随访时，所有患眼炎症消退，视力提高至0．60±0．29，RPR滴度下降4倍以上，平均为1：18．8。早期诊断治疗的患者中，视力完全恢复。结论梅毒在眼后节的主要表现是脉络膜视网膜炎；在眼后节炎症性疾病的鉴别诊断中，应注意排除包括梅毒在内的感染性因素；及时的血清学检查、有效的青霉素治疗，有利于患者获得很好的视力预后。

Objective To evaluate the clinical features and treatment outcomes of ocular posterior segment syphilis. Methods The clinical data of 24 patients with active ocular syphilis were retrospectively reviewed. The diagnosis was made first in eye clinic,and verified by treponema pallidum particle agglutination （TPPA） and rapid plasma reagin （RPR）. The patients, 17 males and 7 females, aged from 30 to 63 years with an average of 47.6 years. The duration of symptoms ranged from 3 days to 2 years with an average of 5.8 months （≤1 month, 7 cases; 1-3 month, 5 cases; 3-6 months, 5 cases; 〉6months, 7 cases）. There were 18 bilateral cases and 6 unilateral cases. The result of human immunodeficiency virus （HIV） test was negative for all cases. Twenty-three patients received systemic penicillin therapy and 1 patient was treated with oral erythromycin due to penicillin allergy. Before treatment, the mean visual acuity was 0.17-0.19,the mean titer of RPR was 1：84. The follow-up period was half a year. Results The major ocular manifestations included bilateral （16 cases） or unilateral （1 case） chorioretinitis, unilateral retinal vasculitis （2 cases ）, unilateral neuroretinitis （2 cases ）, and bilateral （2 cases） or unilateral （1 case） optic neuritis. The mean follow-up visual acuity was 0.60±0.29, the mean follow up titer of RPR was1：18.8. Some patients had got the diagnosis and prompt treatment at the early stage of the disease and their visual acuity recoveried very well. Conclusions The major manifestion of ocular posterior segment syphilis is chorioretinitis. It is important to consider the possibility of syphilis when patients have inflammation of posterior segment. Prompt serology examination and penicillin treatment are the keys to cure ocular syphilis.