26例以精神症状为首发的神经梅毒患者临床特征分析

Clinical characteristics analysis of 26 patients with neurosyphilis with psychiatric symptoms as first episode

目的分析以精神症状为首发的神经梅毒的临床特征。方法对2017年1月至2019年1月就诊于该院的26例神经梅毒患者病历资料进行回顾研究。结果26例神经梅毒病例中,均以首发表现为精神病性症状就诊于精神科,表现为精神分裂样症状、焦虑、抑郁、躁狂、认知功能损害等;神经系统查体无特异性体征;26例患者血清及脑脊液梅毒甲苯胺红不加热试验(TRUST)和梅毒螺旋体明胶颗粒凝集试验(TPPA)阳性;65%患者存在非特异性异常的脑影像学表现。经治疗后患者血清TRUST滴度降低,精神症状改善。结论神经梅毒症状复杂多变,早期识别能改善预后。

Objective To analyze the clinical characteristics of neurosyphilis with psychiatric symptoms as first episode. Methods A retrospective study was conducted on the medical records of 26 patients with neurosyphilis who were admitted to this hospital from January 2017 to January 2019. Results Among the 26 cases of neurosyphilis,all patients were admitted to the department of psychiatry with the psychotic symptoms as first episode,including schizophrenia-like symptoms,anxiety,depression,mania,cognitive impairment,etc.There was no specific signs during nervous system examination.26 patients were positive for toluidine red unheated serum test (TRUST) and treponema pallidum partical (TPPA) in serum and cerebrospinal fluid.Non-specific abnormalities were found in 65% of patients.After treatment,serum TRUST titers decreased and psychiatric symptoms improved. Conclusion The symptoms of neurosyphilis are complex and changeable,and early identification can improve the prognosis.