神经梅毒37例回顾性临床分析

Retrospective clinical analysis of 37 cases of neurosyphilis

目的 研究神经梅毒（NS）临床表现和诊断治疗的方法.方法 回顾性分析北京协和医院自1999年1月至2012年5月间住院期间确诊的37例NS患者的临床资料.结果 自2006年以来,诊断NS患者数明显上升.确诊病例中发病年龄中位数45（27～71）岁,男女比例为2.4∶1.其中3例合并HIV感染.无症状NS5例（占13.5%）,有症状脑膜炎型11例（占29.7%）,脑膜血管梅毒7例（占18.9%）,实质性NS14例（占37.8%）,其中麻痹性痴呆10例,脊髓痨4例.37例患者CSF TPHA均为阳性,26例（占70%）RPR阳性.平均脑脊液压力149mmH2O,8例（占22%）脑脊液压力升高（≥180mmH2O）;13例（占35%）脑脊液白细胞数〉10/μl;平均脑脊液蛋白0.78g/L,24例（占65%）蛋白升高（〉0.5g/L）;接受青霉素及头孢曲松治疗、随访记录完整的17例患者中,11（36%）例临床症状改善,10例脑脊液蛋白及异常淋巴细胞增多改善,7例RPR滴度下降或转阴.结论 近年来神经梅毒发病率升高,其临床表现复杂多样,脑脊液检查为诊断NS的主要手段.对于HIV患者,应提高对神经梅毒的警惕性.

Objective To review the nature of the presentation of neurosyphilis, the diagnostic feature and the treatment of the disease. Method a retrospective review was carried out of the records of 37 patients who had been identified as cases of neurosyphilis in PUMCH from Jan 1999 to May 2012. Result There has been a rapid rise in diagnoses of neurosyphilis in our hospital since 2006. The median age of onset was 45 years, with sex ratio （ male ： female） 2.4：1.3 patients were with HIV co-infection. Among 37 patients, 5 （ 13.5% ） patients presented with asymptomatic neurosyphilis; 11 （29.7%） presented with syphilitic meningitis; 7 （ 18.9% ） patients presented with meningovascular syphilis and the remainder 14 （37.8%） had presentations of parenchymatous syphilis, including 10 general paresis and 4 tabes dorsalis. The cerebrospinal fluid （CSF） TPHA （Treponema pallidum haemagglutination） tests of 37 patients were all positive and CSF RPR（ Rapid Plasma Reagin） tests were positive in 26（70% ） cases. The average intracranial pressure （ICP） was 149mmH2 O, with 8 （ 22% ） cases above normal; 13 （ 35 % ） cases presented with CSF pleocytosis; the average CSF protein was 0. 78g/L, with 24（65% ）cases having an elevated protein con- centratoin. Among 17 cases who accepted penicilin and ceftriaxone therapy, as well as follow-up CSF examination, 11 （36%） cases achieved reverse syptoms; 10 cases achieved protein reduced and pleocytosis improved ;7 cases achieved RPR titer declined or even reverted to negative in their CSF. Conclusion The incidence of neurosyphilis has been increased in China over the past decade. Due to its complicated manifestations, CSF examination remained the crucial diagnostic criteria for NS. Practitioners should be more ＂alert on NS in HIV era.