神经梅毒54例临床及实验室特点分析

Clinical and Biological Characteristics of 54 Cases of Neurosyphilis

目的了解神经梅毒的临床及实验室特点。方法回顾性分析2015-2019年本院120例梅毒住院患者,使用SPSS软件进行统计分析。结果 66例非神经梅毒和54例神经梅毒患者,性别、年龄差异均有统计学意义(P<0.001)。29例有症状神经梅毒者,从出现神经精神系统症状到诊断神经梅毒的时间为(11.53±17.00)个月。神经梅毒患者血清TRUST滴度高于非神经梅毒患者,有症状神经梅毒患者脑脊液TRUST滴度高于无症状神经梅毒患者,其中18例神经梅毒患者治疗前后比较,治疗后血清TRUST滴度、脑脊液TRUST滴度均低于治疗前,差异均有统计学意义(P<0.001)。有症状神经梅毒比无症状神经梅毒患者脑脊液有核细胞数高,但是差异无统计学意义(P=0.227)。有症状神经梅毒比无症状神经梅毒患者脑脊液蛋白、IgG、IgA、IgM高,差异均有统计学意义(P<0.001)。神经梅毒治疗后脑脊液有核细胞数、蛋白、IgG、IgA、IgM均下降,差异有统计学意义(P<0.001)。ROC曲线显示,脑脊液免疫球蛋白曲线下面积大于脑脊液细胞数和蛋白。结论神经梅毒的诊断常延迟。男性患者、出现精神症状,同时伴有神经系统症状者,需要积极行腰穿脑脊液检查以早日发现神经梅毒。除了脑脊液TRUST、TPPA、有核细胞数、蛋白等检测外,脑脊液免疫球蛋白检测有助于神经梅毒的诊断。

Objective To understand the clinical and laboratory characteristics of neurosyphilis.Methods This retrospective study of 120 syphilis patients who were hospitalized in our department between 2015 and 2019.Results There were 54 patients with neurosyphilis,66 patients with non-neurosyphilis.The neurosyphilis and non-neurosyphilis patients significantly differed with respect to gender and age(P<0.001).The time from neuropsychiatric symptoms to neurosyphilis diagnosis was(11.5±17.0)months.The serum TRUST titers of neurosyphilis patients were significantly higher than those of non-neurosyphilis patients,the cerebrospinal fluid TRUST titers of symptomatic neurosyphilis patients were significantly higher than those of asymptomatic neurosyphilis patients(P<0.001).The serum and the cerebrospinal fluid TRUST titers after the treatment weresignificantly lower than those before the treatment in 18 neurosyphilis patients( P< 0. 008) . The number of CSF cells in symptomatic neurosyphilis was higher thanthat in asymptomatic neurosyphilis,but the difference was not significant ( P =0. 227) . The levels of cerebrospinal fluid protein,IgG,IgA and IgM in symptomaticneurosyphilis patients were significantly higher than those in asymptomaticneurosyphilis patients ( P < 0. 001,respectively ) . After the treatment,in 18neurosyphilis patients,the number of CSF cells,protein,IgG,IgA and IgMsignificantly decreased( P < 0. 001,respectively) . ROC curve showed that the areaunder the curve of cerebrospinal fluid immunoglobulin was larger than the numberof cerebrospinal fluid cells and protein. Conclusion The diagnosis of neurosyphilisis often delayed. Male patients with mental or accompanying neurologicalsymptoms should be examined for neurosyphilis. In addition to cerebrospinal fluidTRUST,TPPA,number of nucleated cells and protein,cerebrospinal fluidimmunoglobulin could be implemented in the diagnosis of neurosyphilis.