艾滋病合并神经梅毒的临床特征分析

Clinical features of AIDS patients complicated with neurosyphilis

目的了解艾滋病(AIDS)合并神经梅毒(NS)的临床特征,为该病的诊治提供帮助。方法回顾分析近1年多来22例AIDS合并NS患者的病史、临床表现、实验室检查、头颅CT及MRI检查情况。结果22例患者均为男性,近半数有男-男性行为史。18例为无症状型NS,4例为有症状型,其中脑实质型2例、脑血管型2例。血清快速血浆反应素环状卡片试验(RPR)滴度≥1:32者19例(86 6%),有症状型患者头颅影像学检查均有异常。所有患者均进入AIDS期,需进行驱梅及抗人类免疫缺陷病毒(HIV)治疗。结论本组AIDS合并NS的患者以无症状型多见,需积极驱梅、抗HIV治疗,对于血清RPR滴度≥1:32的患者,随访中应加强脑脊液复查。对于出现神经系统症状的年轻男性患者,需警惕AIDS合并NS的发生。

Objective To review the clinical features of AIDS patients complicated with neurosyphilis （NS）. Methods The medical history, clinical manifestation, laboratory tests, head CT and MRI findings of 22 AIDS patients complicated with NS were retrospectively analyzed. Results All patients were males, and half of whom had history of man having sex with man （MSM）. Among 22 cases, 18 were asymptomatic; and 4 were symptomatic NS, including 2 cases of parenchymal type and 2 cases of cerebrovascular type. Nineteen patients （86.6%） presented positive RPR testing （≥1：32）. The head imaging findings were abnormal in all symptomatic patients. All patients received anti-syphilis and anti-HIV therapy. Conclusion Neurosyphilis complicated with AIDS is not rare, and for young patients with nervous system symptoms, possibility of the disease should be concerned.