不同时期神经梅毒患者临床特征及血清学和脑脊液检测分析

Analysis of clinical features,serologic and cerebrospinal fluid tests in patients with neurosyphilis at different stages

目的总结不同时期神经梅毒患者临床特征以及梅毒血清学和脑脊液检测特点。方法回顾分析12例不同时期神经梅毒患者[早期神经梅毒5例,包括4例脑(脊)膜梅毒、1例脑(脊)膜血管梅毒;晚期神经梅毒7例,均为麻痹性痴呆]的临床症状、影像学表现、梅毒血清学和脑脊液检测、治疗及预后。结果 12例神经梅毒患者血清抗梅毒螺旋体特异性抗体和快速血浆反应素试验(RPR)、脑脊液抗梅毒螺旋体特异性抗体均呈阳性,9例脑脊液RPR试验阳性。5例早期神经梅毒患者中1例脑脊液压力升高、3例白细胞计数增加、4例蛋白定量升高;7例晚期神经梅毒患者中1例脑脊液压力升高、7例白细胞计数增加、7例蛋白定量升高,脑脊液细胞学均呈淋巴细胞反应且以小淋巴细胞为主。12例患者分别静脉滴注不同剂量青霉素或肌肉注射头孢曲松钠,8例神经精神症状明显好转、4例未见明显改善。结论神经梅毒发病形式多样,临床症状不典型,极易误诊。明确诊断需依靠临床表现及梅毒血清学和脑脊液检测,早期诊断和规范治疗对改善预后和减少并发症至关重要。

Objective To summarize the clinical features, serologic, cerebrospinal fluid （CSF） tests in patients with neurosyphilis at different stages. Methods A retrospective analysis was made on the clinical features, imaging, serologic and CSF tests, treatment and prognosis of 12 cases diagnosed as neurosyphilis. In those cases, 5 cases were early-stage neurosyphilis, including 4 syphilitic meningitis （meningomyelitis） and one meningovascular syphilis; 7 cases were late-stage neurosyphilis, all of whom were general paresis. Results The serum Treponema pallidum antibody （TP-Ab） and rapid plasma regain （RPR） tests were positive in all 12 cases. The CSF TP-Ab tests of 12 cases were all positive and CSF RPR tests were positive in 9 cases. In 5 cases of early-stage neurosyphilis, one case had elevated intracranial pressure （ICP）, 3 cases presented with elevated white blood cell （WBC）, 4 cases had elevated protein concentration. In 7 cases of late-stage neurosyphilis, one case had elevated ICP, 7 cases presented with elevated WBC and protein concentration. CSF cytology showed lymphocyte reaction, mainly small lymphocytes. All cases were treated with different doses of intravenous penicillin or eeflriaxone sodium by intramuscular injection, among whom 8 cases presented improved neuropsychiatric symptoms, while 4 cases had no significant improvement. Conclusions Neurosyphilis is easy to be misdlagnosed because of various styles of onset and nontypical clinical manifestations. A definite diagnosis depends on clinical manifestations and serologic and CSF examinations. Early diagnosis and standard treatment is essential for improving prognosis and reducing complications.