合并与未合并HIV感染的神经梅毒患者临床特征

Clinical characteristics and prognosis of 80 cases with neurosyphilis

目的比较合并与未合并HIV感染的神经梅毒患者临床特征及短期预后差异,以期为神经梅毒诊治提供参考。方法回顾性分析2017年1月至2020年6月重庆市公共卫生医疗救治中心感染科收治的神经梅毒(NS)住院患者的临床资料。按是否合并HIV感染,分为HIV合并神经梅毒患者和HIV阴性的神经梅毒患者,比较两组患者的一般资料、感染途径、临床分型、血RPR/TPPA、脑脊液检查及其临床转归等是否存在差异。结果本研究共纳入80例患者,平均年龄(40.6±13.6)岁,男性74例,占92.5%。其中HIV合并神经梅毒患者(HIV/NS组)59例,HIV阴性的神经梅毒患者(NS组)21例。与NS组比较,HIV/NS组患者平均年龄较小(37.4±12.0岁vs.49.5±14.2岁),感染途径以同性性行为感染多见(62.7%vs.0)。在临床表现方面HIV/NS组患者以脑脊膜型最常见,占37.3%(22/59),NS组患者则以麻痹性痴呆型最常见,占52.4%(11/21)。HIV/NS组患者脑脊液压力、白细胞计数、脑脊液总蛋白、脑脊液RPR阳性率与NS组比较差异均无统计学意义(P均>0.05)。所有患者均好转出院,但HIV/NS组患者平均住院天数(21.5±4.5)明显长于NS组(17.5±4.0)(P<0.05)。结论神经梅毒诊断,需结合性别、患病人群、是否合并HIV感染、血梅毒滴度等多方面综合考虑。合并HIV感染的神经梅毒患者与HIV阴性的神经梅毒患者在脑脊液改变、短期预后方面无明显差异,但合并HIV感染者临床类型以脑脊膜型常见,且发病年龄更小。

Objective To compare the clinical characteristics and short-term prognosis of neurosyphilis patients with and without HIV infection,aiming to provide a reference for the diagnosis and treatment of neurosyphilis.Methods Neurosyphilis patients were retrospectively collected from Chongqing Public Health Medical Center from January 2017 to June 2020.The demographic information,transmission route,clinical typing,blood RPR/TPPA,cerebrospinal fluid examination,and their clinical outcome were compared between patients with and without HIV.Results Of 80 patients with neurosyphilis,with an average age of 40.6±13.6 years old,and 74 males(92.5%).Among them,there were 59 patients with HIV(HIV/NS group)and 21 without HIV(NS group).Compared with the NS group,the mean age in the HIV/NS group was smaller(37.4±12.0 vs 49.5±14.2),and homosexual transmission was more common(62.7%vs 0).Cerebrospinal meningitis(37.3%,22/59)was the most common type of neurosyphilis in the HIV/NS group,while paralytic dementia(52.4%,11/21)was the most common type of neurosyphilis in the NS group.There were no significant differences in CSF pressure,white blood cell count,CSF total protein,and CSF RPR positive rate between the two groups(P>0.05).All patients improved and were discharged from the hospital,but the average length of stay in the hospital in the HIV/NS group(21.5±4.5 days)was significantly longer than that in the NS group(17.5±4.0 days)(P<0.05).Conclusions The diagnosis of neurosyphilis should be based on gender,affected population,HIV infection,and titer of blood syphilis.There was no significant difference in cerebrospinal fluid changes and short-term prognosis among neurosyphilis patients with or without HIV.However,cerebrospinal meningitis is the most common disease among neurosyphilis patients with HIV,and the onset age was younger.