神经梅毒的临床特征(附12例报道)

Clinical characteristics of neurosyphilis:report of 12 cases

目的通过分析神经梅毒的临床特征,探讨其诊断的相关问题。方法回顾性分析经临床和实验室检查确诊的12例神经梅毒住院患者的相关临床资料。结果12例患者中男7例,女5例,平均年龄37.25岁。均承认自己或配偶有非婚姻性生活史。脑脊液检查示全部患者脑脊液梅毒螺旋体血球凝集试验(CSF-TPHA)阳性,脑脊液快速血浆反应素试验(CSF-RPR)阳性者8例,白细胞和蛋白均升高者6例,白细胞单独升高3例,蛋白单独升高1例。头颅MRI表现为脑梗死、脑萎缩、占位性病灶、炎症样病变。12例患者中无症状神经梅毒1例,梅毒性脑膜炎2例,脑膜血管梅毒6例,麻痹性痴呆1例,脊髓痨2例。结论神经梅毒的诊断应综合考虑病史、临床表现、梅毒血清学、脑脊液、影像学等资料。

Objective To study the clinical characteristics in order to provide basis for the diagnosis of neurosyphilis. Methods Clinical data of 12 cases of nenrosyphilis were retrospectively studied. Results In the 12 cases, 7 were male and 5 were female. Their average age was 37.25 years. They or their spouse experienced sexual life history out of their marriage. All of patients were reactive to treponema pallidum hmagglutination assay （TPHA） of the cerebrospinal fluid （CSF）. Eight patients were reactive to rapid plasma reagent test （RPR）. CSF examination revealed an increase in white blood cells in three cases, in protein in one case, and in both in six cases. Changes of cerebral infarction, cerebral atrophy, space-occupying lesion or demyelination were found on the cranial MRI. One case was diagnosed as asymptomatic neurosyphilis, two cases as syphilitic meningitis, six cases as meningovasculer syphilis, one case as general paresis and two cases as tabes dorsalis. Conclusions The diagnosis of neumsyphilis may be based on the combination of the history, clinical manifestations, serum test of syphilis antibody, CSF examination and imaging data.