22例神经梅毒的临床特点及误诊情况分析

Clinical characteristics of 22 cases of neurosyphilis and misdiagnosis analysis

目的总结分析神经梅毒误诊和(或)漏诊原因。方法选取2011年7月至2018年5月安徽中医药大学神经病研究所附属医院诊治的22例神经梅毒患者作为研究对象。对其临床分型、冶游史问诊、诊断、是否合并他神经系统疾病等进行比较分析。结果出院诊断分型与文献Fisher概率P>0.05,入院诊断、修正诊断一致性检验(Kappa=0.353,P<0.05),优势性检验P<0.05,前后冶游史问诊一致性检验(Kappa=0.009,P>0.05),优势性检验P<0.05。有、无症状神经梅毒并存疾病的Fisher概率P<0.05。结论神经梅毒临床表现不典型或无症状,加上多数患者隐瞒冶游史,极易造成误诊和(或)漏诊,临床应注重神经梅毒定性、定位分析,常规进行血液和(或)脑脊液的筛查。

Objective To summarize and analyze the causes of misdiagnosis and/or missed diagnosis of neurosyphilis.Methods The clinical data of 22 patients with neurosyphilis admitted to the Affiliated Hospital of Anhui Institute of Neurology of Anhui University of Chinese Medicine from July 2011 to May 2018 were retrospectively analyzed.Comparative analysis on the clinical classification,the results of the history of unclean sexual behavior,diagnosis,and whether neurosyphilis was associated with other neurological diseases were performed.Results There was no statistically significant difference in Fisher's Probability Test between hospital discharge diagnosis and literature classification(P>0.05).There was a statistically significant difference between the admission diagnosis and the corrected diagnosis(Kappa=0.353,P<0.05),and the dominance test was statistically different(P<0.05).There was no statistically significant difference between the pre-reported and post-reported unclean behavioral statements(Kappa=0.009,P>0.05),and the dominance test was statistically different(P<0.05).There was a statistically significant difference in the Fisher's Probability Test for symptomatic neurosyphilis and asymptomatic neurosyphilis with other neurological diseases(P<0.05).Conclusions The clinical manifestations of neurosyphilis are atypical or asymptomatic,and most patients conceal unclean sexual behavior,which can easily lead to misdiagnosis and/or missed diagnosis.Qualitative,localized analysis of neurosyphilis,as well as routine screening of blood and/or cerebrospinal fluid for syphilis antibodies,may help reduce the rate of misdiagnosis and/or missed diagnosis.