脊髓痨临床和影像学特征分析

Analysis of clinical and imaging characteristics of tabes dorsalis

目的 总结脊髓痨的临床和影像学特征。方法 回顾分析海军总医院明确诊断的3例及文献报道的7例脊髓痨患者的临床症状与体征、实验室检查、影像学表现、电生理学表现、治疗及预后。结果 10例患者分别以行走不稳、腰腹部和双下肢针刺样或闪电样疼痛、四肢麻木（以双下肢显著）首发,临床主要表现为行走不稳、双下肢麻木、躯干和四肢针刺样或闪电样疼痛、排尿障碍等,以及双下肢腱反射减弱或消失、Romberg征阳性、深感觉障碍、跟-膝-胫试验欠稳准、浅感觉障碍等。血清梅毒螺旋体明胶凝集试验（TPPA）阳性,快速血浆反应素试验（RPR）滴度1∶8~256;脑脊液白细胞计数增加、蛋白定量升高,脑脊液TPPA试验阳性、RPR试验滴度1∶1~8。影像学改变无特异性,多表现为退行性变。体感诱发电位呈现双侧P100波潜伏期延长、波幅降低;神经传导速度无明显变化。其中6例患者经青霉素治疗后症状均缓解。结论 脊髓痨临床表现复杂、影像学改变无特异性,易误诊,明确诊断应综合临床症状与体征、实验室检查、影像学和电生理学表现,仅少数患者表现出相应的影像学改变,对诊断有一定提示意义。

Objective To analyze the characteristics of clinical symptoms and imaging features of tabes dorsalis. Methods We retrospectively analyzed clinical signs and symptoms, laboratory examinations, imaging features, electrophysiological manifestations, treatment and prognosis of 3 patients with tabes dorsalis diagnosed in our hospital and 7 patients reported in literatures. Results The initial symptoms of 10 patients with tabes dorsalis included unsteady gait, pricking or lightning pain in abdomen and numbness of limbs （especially in both legs and feet）. In addition to the above symptoms, the most common clinical features also included urination disorders, weakened or disappeared reflexes at knee and ankle, disorders of deep and shallow sensation, Romberg sign positive and heel-knee-tibia test instability. Treponema pallidum particle agglutination assay （TPPA） in serum of all patients was positive, and the titer of rapid plasma reagin （RPR） in serum was 1 ： 8-256. Cerebrospinal fluid （CSF） test showed increased white blood cell and protein. TPPA in CSF was also positive, and the titer of RPR in CSF was 1： 1-8. No obvious specificity of imaging changes was found except spinal disc degeneration. Some patients showed abnormal somatosensory- evoked potential （SEP） with prolonged latency and decreased amplitude of bilateral P100 waves, and the nerve conduction velocity （NCV） of most patients was normal. Six patients were improved after penicillin treatment. Conclusions Due to its complicated clinical manifestations and non-specific imaging changes, tabes dorsalis is prone to be misdiaguosed. A clear diagnosis depends on clinical signs and symptoms, laboratory examinations, imaging and electrophysiological manifestations. Only a minority of patients show imaging changes which are proved significant for the diagnosis of tabes dorsalis.