脊髓痨19例临床特点分析

Clinical analysis of tabes dorsalis

目的探讨脊髓痨的临床特点,为临床医生提供指导。方法回顾性分析19例脊髓痨患者的临床资料,其中男16例,女3例。年龄36~68岁。所有患者均经梅毒血清特异性抗体测定(TPPA)、梅毒荧光抗体吸附试验(FTA-ABS)及梅毒甲苯胺红不加热血清试验(TRUST),并结合临床症状确诊,给予青霉素治疗。总结脊髓痨的临床表现、实验室检查、神经电生理及影像学检查的特点。结果 19例脊髓痨患者均慢性起病,进行性加重,以双下肢麻木或无力、走路不稳为主要临床表现。体征有双下肢音叉振动觉减退或消失,闭目难立征阳性,双下肢腱反射减弱或消失。血清和脑脊液梅毒螺旋体特异性抗体和梅毒荧光抗体吸附试验Ig G阳性,影像学无特异性表现。经青霉素治疗,所有患者临床症状均有好转。结论脊髓痨患者主要以双下肢症状起病,确诊主要依靠临床症状及实验室检查,青霉素治疗有效。

Objective To investigate the clinical features of tabes dorsalis and provide guidance for clinicians. Methods The clinical data of 19 patients with tabes dorsalis were retrospectively analyzed. The patients＇ age ranged from 36 to 68 years old. Among them, 16 patients were male and 3 patients were female. All patients were diagnosed by syphilis serum specific antibody （TPPA） , syphilis fluorescent antibody adsorption test （FTA - ABS）, syphilis toluidine red unheated serum test （TRUST） and clinical symptoms. All patients were treated with penicillin. We summarized the characteristics of clinical manifestation, laboratory examination, electrophysiology and imaging examination in tabes dorsalis. Results The 19 tabes dorsalis patients had chronic onset with walking instability, signs of weakness or sensation disorder in bilateral lower extremity, and positive Romberg＇s sign. All 19 patients had positive syphilis examination in serum and eerebrospinal fluid and met the diagnostic criteria of neurosyphilis. The MRI manifestations and Somato sensory evoked potential were not specific. All patients improved after penicillin treatment. Conclusions Tabes dorsalis patients predominantly present with lower extremity symptoms and the diagnosis depends on the clinical symptoms and laboratory examination. Penicillin is effective for tabes dorsalis.