脊髓痨的临床特点及误诊原因分析

Clinical Features of Myelophisis and Its Misdiagnosis:Report of 4 Cases and Literature Review

目的探讨脊髓痨的临床表现,分析其误诊原因,为临床医生提供指导。方法回顾性分析我院收治的4例脊髓痨患者的临床表现、实验室检查、肌电图检查及影像学检查,并结合国内文献报道的23例脊髓痨患者的临床症状,与国外文献进行对比分析。结果 4例脊髓痨患者均有慢性进行性走路不稳,腱反射减弱或消失,双下肢关节位置觉和运动觉减退或消失,Romberg征阳性,血清梅毒螺旋体特异性抗体梅毒酶联免疫试验(TP-ELISA)均为阳性。双下肢针刺样疼痛2例;排尿障碍2例;双眼视力下降1例(先天梅毒者),双眼视神经萎缩1例,视野缩小(管状视野)1例,阿-罗瞳孔1例,双瞳孔不等大2例;面神经麻痹2例;脑脊液细胞计数升高2例;肌电图在正常范围内1例,异常1例。结论国内脊髓痨患者呈现"不典型"表现。其原因可能与病程短,主要临床表现未出现有关,而临床症状的"不典型"表现是产生误诊和漏诊的主要原因之一。故对有共济失调、深感觉障碍、闭目难立征阳性等症状患者应做血清和脑脊液梅毒检测。

Objective. To summarize the clinical manifestations of myelophthisis and analyze the reasons of misdiagno- sis. Methods We retrospectively analyzed the clinical data of 4 patients with myelophthisis in our hospital. Meanwhile, the data of 23 patients who were previously reported in Chinese literature were reviewed and compared with foreign literature. Results All these 4 patients in our hospital presented with walking unsteadiness, attenuated or missing knee reflex, and Romberg＇s sign, which were consistent with international literature. Among these 27 Chinese patients, 13 presented with fulgurate and nee- dling pain, 9 with disturbance of micturition, 5 with Argyll - Robertson pupil. No visceral crisis or nutritional disturbance was observed. Eleven patients presented with peripheral sensation abnormality and 15 with limbs anesthesia. Other findings included lancinating pain of the lower limbs （ n = 2）, voiding dysfunction （ n = 2）, binocular vision loss （ n = 1, with congenital syphi- lis）, bilateral optic atrophy （ n = 1 ）, reduced vision （ tunnel vision） （ n = 1 ）, Argyll - Robertson pupil （ n -- 1 ）, anisocoria （ n = 2）, facial palsy （ n = 2）, and elevated cerebrospinal fluid cell count （ n = 2）. Conclusion Chinese patients with myeloph- thisis tend to be presented with ＂ untypical＂ manifestation, which may be mainly due to short course of disease and subsequently the lack of typical clinical manifestations. These ＂ atypical＂ clinical manifestations can easily result in misdiagnosis and missed diagnosis. Therefore, serum and cerebralspinal fulid tests for syphilis should be performed for patients who are presented with ataxia, disturbance of deep sensation, and Romberg＇s sign.