32例神经梅毒患者血清学诊断与临床分析

Serological diagnosis and clinical analysis of 32 cases with neurosyphilis

目的探讨神经梅毒患者的临床特征、实验室检查、诊断和治疗情况。方法选择2003年1月至2009年12月我院收治的32例神经梅毒患者资料进行回顾性分析。结果 32例神经梅毒患者中麻痹性痴呆10例,脑卒中样12例,脊髓损害5例,视神经损害3例,梅毒性脑膜炎2例;血清梅毒甲苯胺红不加热血清反应素试验(toluidine red unheated serum test,TRUST)及梅毒螺旋体明胶颗粒凝集试验(treponema palliadum particle agglutination assay,TPPA)均呈阳性反应;部分患者脑脊液检查显示脑脊液压力升高、蛋白质含量升高、白细胞计数升高(以单核细胞为主)。结论脑脊液梅毒诊断试验是神经梅毒诊断的重要依据,同时结合临床表现、其他实验室资料的综合分析,对本病的治疗和预后有重要意义。

Objective To explore the clinical characteristics, laboratory test results, diagnosis and treatment of the patients with neurosyphilis. Methods 32 cases of patients with neurosyphilis were selected from the First Affiliated Hospital of Sun Yat-sen University. Retrospective analysis was made on laboratory and clinical data. Results 32 cases of neurosyphilis were analysed. The number of the cases with dementia paralytic, cerebral stroke, spinal cord lesion, optic nerve injury and syphilitic meningitis was 10, 12, 5, 3 and 2, respectively. The results of syphilis toluidine red unheated serum test （TRUST） and the serum treponema palladium particle agglutination assay（TPPA） were positive in all cases. Part of them had different degrees of increase in the cerebrospinal fluid＇s pressure, protein and white blood cell count （usually mononuclear cells）. Conclusion Diagnostic tests of CSF for syphilis are important for diagnosis of neurosyphilis and integrated analysis with the clinical manifestation and other laboratory information is significant for treatment and prognosis.