神经梅毒38例临床分析及文献复习

Diagnosis and treatment analysis of 38 cases of neurosyphilis and literature review

目的探讨神经梅毒患者的临床特征、实验室检查、早期诊断、分型依据和治疗情况。方法选择2004-09~2014-01江苏大学附属医院、镇江市第一人民医院和江苏大学附属第四人民医院收治的38例神经梅毒患者资料进行回顾性分析。结果 38例患者中男28例,女10例,年龄1 d^75岁,平均51.1岁,神经梅毒患者中间质型10例(脑膜血管梅毒8例,脊髓膜血管梅毒1例,脑膜神经梅毒1例),主质型22例(麻痹性痴呆14例,脊髓痨8例),视神经损害2例,无症状型神经梅毒3例,先天性神经梅毒1例;血清、脑脊液快速血浆反应素试验(RPR)及梅毒螺旋体特异抗体测定(TPPA)均阳性,部分患者脑脊液检查显示脑脊液蛋白质含量升高和白细胞计数升高(以单核细胞为主)。除3例放弃治疗外,35例经治疗后好转的患者血清及脑脊液抗体滴度均有不同程度降低,脑脊液白细胞数、蛋白量均降至正常。结论神经梅毒可防可治,脑脊液梅毒诊断试验是神经梅毒诊断的重要依据,同时需结合临床表现及其他检查进行综合分析,及时正确治疗能够控制病情。

Objective To investigate the clinical characteristics laboratory examination,early diagnosis,the basis of classification and treatment of the patients with neurosyphilis. Methods The data of 38 patients with neurosyphilis from September 2004 to January 2014 in Fourth People＇s Hospital Affiliated to Jiangsu University,Zhenjiang First People＇s Hospital and the Fourth People＇s Affiliated Hospital of Jiangsu University were analyzed retrospectively. Results In this group,there were 38 patients,male 28 cases,female 10 cases,age 1 - 75 years old,mean51. 1 years,including 10 cases of interstitial neurosyphilis（ 8 cases of meningovascular neurosyphilis,1 cases of spinal meningovascular neurosyphilis,1 patients with meningeal neurosyphilis）,22 cases of parenchyma type（ 14 cases of paralytic dementia,8 cases of tabes dorsalis）,2 case of optic nerve injury,3 cases of asymptomatic neurosyphilis,1 cases of congenital syphilis; serum,CSF RPR and TPPA in all patients were positive. In part of patients cerebrospinal fluid examination showed elevated cerebrospinal fluid protein content,the increased white blood cell count（ mainly monocytes）. Except3 cases giving up treatment,35 cases recovered after treatment,the serum antibody titre and CSF antibody titers were reduced to varying degrees,CSF white blood cell count,protein decreased to normal.Conclusion Neurosyphilis is preventable and curable,cerebrospinal fluid test for syphilis is an important basis for the diagnosis of neurosyphilis,but it is necessary to make a comprehensive analysis based on clinical manifestations,other examination in order to obtain the final diagnosis,and correct and timely treatment can control the disease.