神经梅毒3例及文献复习

Clinical analysis of neurosyphilis in 3 cases and the literature review

目的:总结神经梅毒的临床特点及诊断。方法:通过收集3例神经梅毒的临床资料,并检索中国生物医学文献、维普、万方等数据库1994-2014年在核心期刊公开发表的关于神经梅毒文献进行回顾分析。结果:纳入133篇,1 208例病人(不包含本文3例),男971例(80.38%),女237例(19.62%),男女比例4∶1;年龄15~80岁,60岁以上126例(10.43%)。有冶游史(包括配偶)634例(52.48%),合并人类免疫缺陷病毒阳性16例(1.32%),误诊635例(52.57%)。临床分型包括无症状型80例(6.62%),脑(脊)膜型149例(12.33%),脑(脊)膜血管型389例(32.20%),麻痹性痴呆457例(37.83%),脊髓痨94例(7.78%),树胶样肿16例(1.32%),混合型22例(1.82%),特殊类型(腓总神经梅毒)1例(0.08%)。结论:神经梅毒多发于青中年男性,临床表现多样,误诊率高,诊断主要靠血清学、脑脊液检查,影像学及电生理检查等无特异性。

Objective：To summarize the clinical characteristics and diagnosis of neurosyphilis. Methods：The clinical data of 3 patients with neurosyphilis were retrospectively analyzed. The literatures about neurosyphilis from in CNKI,VIP and Wanfang database were searched,and these literatures were published in Chinese Sci-tech Core Periodicals from 1994 to 2014. Results：One hundred and thirty-three literatures（1208 patients） were identified,1028 patients（without 3 patients in this article） included 971 male cases （80. 38%） and 237 female cases （19. 62%） and the ratio of male to female was 4：1. The patients age was from 15 to 80 years old, and the patients over 60 years old was 126 cases（10. 43%）. The patients with play history（including spouse） in 634 cases （52.48%）,HIV infection in 16 cases（1. 32%）,and misdiagnosis in 635 cases（52. 57%） were found. The asymptomatic type neurosyphilis in 80 cases（6. 62%）,meningeal（spinal） type neurosyphilis in 149 cases（12. 33%）,meningovascular（spinal） type neurosyphilis in 389 cases（32. 20%）,paralytic dementia in 457 cases（37. 83%）,tabesdorsalis in 94 cases（7. 78%）,syphilitic gumma in 16 cases（1.32%）,mixed type in 22 cases（1. 82%） and special type（common peroneal nerve neurosyphilis） in 1 case （0. 08%） were identified. Conclusions：Neurosyphilis is often found in young and middle-aged men with various clinical manifestations and high misdiagnosis rate, which can mainly be diagnosed by serum and cerebrospinal fluid examination. The imaging and electrophysiological examinations are not specific.