36例神经梅毒的临床特点及诊断分析

Clinical characteristics and diagnosis of neurosyphilis： analysis of 36 cases

目的总结神经梅毒的临床特点及诊断。方法回顾性分析中山大学附属第三医院神经科自2002年1月至2008年11月收治的36例神经梅毒患者的临床分型、临床特点、误诊情况、脑脊液（CSF）检查和MR改变。结果本组患者发病年龄30～78岁，平均48．1岁；男性明显多于女性；常见类型为间质型（18例）、实质型（麻痹性痴呆，10例）、无症状型（4例）神经梅毒；最常见的症状是精神异常及痴呆，其次是局灶神经功能损害如瘫痪、构音障碍等：误诊率高达55．6％．最易被误诊为病毒性脑炎和脑血管意外；CSF的生化异常表现为白细胞数增加、蛋白升高：CSF．梅毒螺旋体明胶凝集试验（TPPA）阳性率（91．7％）明显高于CSF，性病研究实验室试验CSF-（VDRL）阳性率（55．6％）和CSF-梅毒螺旋体IgM抗体试验（CSF-ELISA—TP—IgM）阳性率（38．9％），差异均有统计学意义（P〈0．05）；影像学表现多样化。结论神经梅毒的诊断目前尚无金标准，其临床表现和影像学改变多样化，CSF梅毒螺旋体抗体检查是诊断神经梅毒的重要依据，诊断应主要依靠CSF检查并进行综合分析。

Objective To analyze the clinical characteristics and diagnosis of neurosyphilis. Methods A retrospective study was conducted among 36 patients with neurosyphilis treated in our hospital between February, 2002 and November, 2008. The clinical classification, clinical features, misdiagnosis, laboratory findings of the cerebrospinal fluid （CSF）, and findings in magnetic resonance imaging （MRI） of the patients were analyzed. Results The patients aged between 30 and 78 years （mean 48.1 years）, and male subjects were more frequently affected than female subjects. Meningovascular syphilis was the most common type （50%） of the disease, followed by general paresis （27.8%） and asymptomatic neurosyphilis （11.1%）. The most common symptoms ofneurosyphilis are mental disorders and dementia, followed by focal neurological dysfunction such as paralysis and dysarthria. Misdiagnoses of neurosyphilis, most frequently as viral encephalitis and cerebrovascular accidents, occurred in 55.6% of the patients. CSF examination revealed increased leukocyte count and protein levels. The positivity rate of Treponema pallidum particle agglutination assay of the CSF was 91.7%, significantly higher than that of Venereal Disease Research Laboratory （VDRL） test （55.6%） and CSF-ELISA-TP-IgM test （38.9%） （P〈0.05）. The MRI findings were diverse in these patients. Conclusion No golden standard has been available for the diagnosis ofneurosyphilis, which has diverse clinical manifestations and nonspecific MRI findings. The presence of Treponemal antibody in the CSF is highly supportive for the diagnosis, which can be established after a comprehensive analysis of the laboratory and clinical evidences.