有无症状神经梅毒患者的特点及其治疗效果分析

Analysis of the characteristics of symptomatic and asymptomatic neurosyphilis patients and its treatment effects

目的 探究有无症状神经梅毒的特点,为临床提供早期诊断的依据及治疗方法。方法 选取2013年3月—2015年3月进行治疗的神经梅毒患者83例作为本次研究的对象,按照其是否出现神经系统症状将其分为有症状组45例和无症状组38例,所有患者每天静脉滴注青霉素,剂量为2 400万U,连续治疗2周,随后每周肌肉注射苄星青霉素1次,剂量为240万U,连续治疗3次。分析2组患者快速血浆反应素环状卡片试验（Rapid plasma reagin,RPR）的检测结果、脑脊液常规检测结果、指标检查人数、治疗前后病情改善情况,计量资料采用t检验,计数资料采用χ^2检验。结果 有症状组患者血清的白细胞水平为（19.4±5.6）×10^6/L,蛋白质水平为（57.7±14.9）mg/dl,葡萄糖水平为（2.7±1.5）mmol/L,三者明显高于无症状组（P〈0.05）,有症状组患者脑脊液的葡萄糖水平为（29.5±5.3）mmol/L,白细胞水平为（43.2±13.8）×10^6/L,颅内压力为（189.4±25.1）mm Hg（1 mm Hg=0.133 k Pa）,三者明显高于无症状组（P〈0.05）,有症状组中出现脑脊液蛋白〉50 mg/dl的为27例,出现脑脊液白细胞数〉5个/mm^3的为28例,血清RPR阳性45例,脑脊液RPR阳性45例,均多于无症状组,2组比较差异具有统计学意义（P〈0.05）,有症状组患者在治疗后,95.6%的患者症状均得到改善,无症状组患者在治疗后,97.3%的患者症状均得到改善,2组比较差异无统计学意义（P〉0.05）。结论 对于神经梅毒患者进行血液以及脑脊液等指标的检查可有助于患者的诊断,而青霉素对于神经梅毒患者的治疗效果良好,值得在临床上广泛推广。

Objective To compare the characteristics of symptomatic and asymptomatie neurosyphilis, and provide the basis for the early clinical diagnosis and treatment of neurosyphilis. Methods Total 83 patients with neurosyphilis in our hospital between March 2013 and March 2015 were recruited and randomly assigned into symptomatic group（ n =45 ） and asymptomatie group（ n =38 ） according to the neurological symptoms. All patients once daily received Intravenous infusion of penicillin（24 000 000 U） continuous for two weeks,while weekly intramuscular benzathine（2 400 000 U） continuous for 3 times. The test results of rapid plasma reagin（RPR） ,cerebrospinal fluid,number of patients receiving the tests,and the improvement of patient＇ s condition were compared. Student t-test for the quantitative variables and Chi-square test for the categorical variables were performed. Results The white blood cells count （ 19.4 ±5.6 ）×10^6/L, serum protein level （ 57.7 ±14.9 ） mg/dl, glucose levels （ 2.7 ±1.5 ） mmol/L of symptomatic patients was significantly higher than those of the asymptomatic group, the difference between the two groups was significant （ P 〈 0.05 ） ; the glucose level, white blood cell count and intracranial pressure in the cerebrospinal fluid of patients in the symptomatic group was （29.5 ±5.3 ） mmol/L, （43.2 ＋ 13.8）×10^6/L and （189.4 ±25.1 ）mm Hg, respectively,which were significantly higher than those of the asymptomatic group, the difference between the two groups was significant（ P 〈 0.05 ） ;In the symptomatic group, 27 cases were with the level of cerebrospinal fluid protein 〉 50 mg/dl,28 cases with white blood cell count in the cerebrospinal fluid 〉 5/mm3 ,45 cases with positive serum RPR ,45 cases with positive cerebrospinal fluid RPR, all were higher than those in the asymptomatic group, the difference between the two groups was significant （ P 〈 0.05 ） ; In the symptomatic group, the symptoms of 95.6% of the patients after the treatment were improved;in the asymptomatic group, the symptoms of 97.4% of the patients were improved after the treatment, there was no significant difference between the two groups （ P 〈 0.05 ）. Conclusion The blood and cerebrospinal fluid indicators are helpful for the diagnosis of neurosyphilis. The penicillin is effective for neurosyphilis ,worthy of popularizing in clinical practice.