18例神经梅毒临床分析

Clinical analysis of 18 cases of neurosyphilis

目的 分析神经梅毒的临床特征,探讨其诊断、治疗和预后.方法 对我院2006-2008年诊断的18例神经梅毒进行回顾性分析.结果 18例患者中包括无症状神经梅毒3例,脑脊膜梅毒1例,脑膜血管梅毒7例,麻痹性痴呆5例及颅内占位2例.18例患者血清甲苯胺红不加热血清反应素试验（TRUST）和梅毒螺旋体明胶凝集试验（TPPA）均阳性.16例（88.89%）患者脑脊液TRUST阳性,18例患者脑脊液TPPA阳性.7例脑脊液白细胞升高（≥10×10^6/L）,13例患者脑脊液蛋白＞0.5 g/L.头颅磁共振（MRI）分别表现为脱髓鞘、脑萎缩、脑梗死等.除2例血清TRUST滴度1：4的患者外,所有患者随访3个月时,TRUST滴度均有4倍降低.除1例麻痹性痴呆外,所有患者在随访中临床症状都有所改善.结论 神经梅毒的临床表现多样,容易误诊,其诊断应结合临床表现、实验室及影像学检查综合分析,争取早期诊断、早期治疗以改善预后.

Objective To analyze the clinical features, diagnosis, treatment and prognosis of neurosyphilis. Methods Clinical data on and laboratory findings in 18 cases with neurosyphilis collected in the Affiliated Provincial Hospital, Anhui Medical University from 2006 to 2008 were retrospectively studied.Results Among the 18 patients, 3 sufferred from asymptomatic neurosyphilis, 1 from meningeal syphilis, 7 from meningovascular syphilis, 5 from paralytic dementia, and 2 from intracranial space-occupation. Toluidine red unheated serum reagin test （TRUST） and Treponema pallidum particle agglutination test （TPPA） of sera were positive in all the patients; cerebrospinal fluid （CSF） TRUST was positive in 16 patients, and CSF TPPA in all patients. An increase was observed in CSF leukocyte count in 7 patients and in CSF protein in 13 patients.The findings on cerebral magnetic resonance imaging （MRI） mainly included demyelination, brain atrophy,cerebral infarction, etc. All the patients, except 2 with a TRUST titer of 1：4, experienced a 4-fold decrease in TRUST titer within a 3-month follow up. Clinical symptoms of neurosyphilis improved in all patients except 1 with paralytic dementia. Conclusions The diversity of clinical manifestations usually leads to the misdiagnosis of neurosyphilis, which should be diagnosed based on comprehensive analysis of clinical characteristics as well as laboratory and imaging findings. Early diagnosis and treatment are beneficial to its prognosis.