钩端螺旋体L型脊髓炎(附15例报告)

LEPTOSPIRA L-FORMS MYELITIS: A REPORT OF 15 CASES

目的探讨钩体L型脊髓炎发病机理和防治。方法对15例钩体L型脊髓炎临床表现、实验室检查，并复习文献。结果急性及亚急性或慢性脊髓损害各7、8例，双下肢瘫7例，四肢瘫8例。均有明显的传导束型或节段到感觉障碍及排尿障碍。血培养钩体L型阳性8例，原型构体6例，尿培养：构体L型5例；CSF培养钩体L型5例；血清钩体MAT阳性7例。结论钩体L4脊髓炎的发生可能为构体L型直接损伤脊髓或供血血管，钩体L型致间质炎症病理损伤所致。甲硝哒唑易透过血脑屏障能损坏钩体DNA结构，可减少钩体病后发病。

Aim To investigate the pathogenesis,treatment of leptospira L-forms myelitis. Methods Clinical and lab-oratory examination were made in 15 cases of leptospira L-forms myelitis and the patients were treated accordingly. ResultSIn climical examination,acute and subacute or chronic destruction of medulla spinalis were found in 7 and 8 cases,paraplegia in7,tetiaplegia in 8. Sensational disorder and conductive fasciculus type or segmental type disorder in urination of urinated wereobvious in all cases- ln blood use,L-forms were isolated in 8 cases,and leptospira in 6. In urine use,L-forms were isolated in5- In CSF culture L-forms were isolated in 6,serum MAT was positive in 7. Conclusion Leptospira L-forms myelitis may bedue to the direct damage of rnedulla or its blood supply by leptosipira L-forms. Metraidazobe can pass through blood-brainbarrier and destroy the DNA of leptospira.