晚期神经梅毒的临床及实验室检查特点分析

Clinical features and laboratory test of late stage neurosyphilis

目的:分析晚期神经梅毒的临床以及实验室检查特点。方法:回顾分析我院收治的23例晚期神经梅毒患者与同期25名正常人的临床表现和各项检查结果,对比其差异及特点。结果:对照组无明显临床症状,观察组患者认知程度较低,均未见阿-罗氏瞳孔,多数出现明显双下肢疼痛(12例,52.2%)、大小便失禁(19例,82.6%)等病理体征;观察组脑脊液白细胞、葡萄糖、蛋白质水平均高于对照组;麻痹性痴呆、脊髓痨及混合型晚期神经梅毒患者均有明显的影像学特征表现,视神经萎缩和无明显神经疾病症状的患者MRI扫描无明显异常表现。结论:晚期神经梅毒的临床表现易与病毒性脑炎、老年痴呆等疾病混淆,误诊率高,而MRI扫描对晚期神经梅毒导致的视神经萎缩或无明显病理体征检测特异性较差。实验室脑脊液检查显示其白细胞、葡萄糖、蛋白质水平均明显高于正常人,因此,联合分析临床体征、MRI扫描和实验室脑脊液检查,对诊断晚期神经梅毒有较大指导意义。

Objectives： To analyze the clinical features and laboratory examination of late stage neurosyphilis. Methods： A retrospective analysis was made on 23 patients with late stage neurosyphilis. Their clinical manifestations and laboratory test results were compared with the normal 25 healthy subjects. Results： The normal group showed no clinical symptoms. The syphilis group showed low cognition capabilities and no symptoms of Roche pupil. Most patients complained of obvious double lower limb pain （n = 12,52. 2% ）, incontinence （ n = 19,82. 6% ） and other pathological symptoms. The syphillis group revealed higher level of cerebrospinal fluid, white blood cell, glucose, protein than the normal group. The syphilis group also showed obvious imaging manifestations of paralysis dementia, tabes dorsalis. Conclusion： The clinical manifestations of late stage neurosyphilis can be confused with the symptoms of viral encephalitis and Alzheimer＇ s disease. There is a high risk of misdiagnosis. MRI is insensitive to optic atrophy or non - significant pathological signs caused by late stage syphilis. Laboratory test of cerebrospinal fluid showed the higher lever of white cells, glucose, protein level in the syphilis group than in the normal group. Therefore, a combined examination of clinical symptoms, MRI scan and laboratory test of cerebrospinal fluid can be more accurate and effective in the diagnosis of late stare neurosyphilis.