以精神行为异常为首发症状的67例神经梅毒患者回顾性分析

Retrospective analysis of 67 cases of neurosyphilis with abnormal mental behaviors as the initial symptom

目的分析以精神行为异常为首发症状的神经梅毒患者临床特征,为神经梅毒临床分型、病程判断和疗效监测提供依据。方法回顾性分析苏州大学附属第二医院67例首发症状为精神行为异常的HIV阴性神经梅毒患者的临床资料,采用t检验进行统计学检验。结果67例患者中,男52例(77.6%),女15例(22.4%);中老年63例(94.0%),青少年4例(6.0%);麻痹性痴呆型38例(56.7%),脑膜血管型21例(31.3%),脑膜型1例(1.5%),脊髓痨型3例(4.5%),混合型4例(6.0%)。实验室检查显示,67例患者血清快速血浆反应素环状卡片试验(RPR)和梅毒螺旋体明胶凝集试验(TPPA)以及脑脊液TPPA均为阳性,55例(82.1%)脑脊液RPR阳性,47例(70.1%)脑脊液蛋白>0.45 g/L,50例(74.6%)脑脊液白细胞计数>8×106/L,28例(41.8%)脑脊液IgG水平升高。核磁共振成像检查显示,21例(31.3%)出现多发缺血灶,17例(25.4%)多发脑白质病变,15例(22.4%)发生脑萎缩,8例(11.9%)见梗死灶,2例(3.0%)脑炎样改变。48例患者予水剂青霉素治疗,15例予头孢曲松,4例予多西环素。6个月后随访,46例(68.7%)患者治疗有效,有效组前期病程显著短于治疗无效组(P<0.05)。结论首发症状为精神行为异常的神经梅毒患者以中老年男性居多,MRI检查有助于神经梅毒临床分型和判断转归,早期规范的驱梅治疗可明显改善患者预后。

Objective To analyze clinical characteristics of neurosyphilis patients with abnormal mental behaviors as the initial symptom,and to provide a reference for clinical classification of,as well as outcome prediction and efficacy monitoring in neurosyphilis.Methods Clinical data were collected from 67 HIV-negative neurosyphilis patients with abnormal mental behaviors as the initial symptom in the Second Affiliated Hospital of Soochow University from November 2012 to November 2019,and retrospectively analyzed.Statistical analysis was carried out by using t test.Results Among the 67 patients,52(77.6%)were males,and 15(22.4%)were females;there were 63(94.0%)middle-aged and elderly patients and 4(6.0%)adolescent patients;38(56.7%)patients were diagnosed with progressive general paresis,21(31.3%)with meningovascular neurosyphilis,1(1.5%)with meningeal neurosyphilis,3(4.5%)with tabes dorsalis,and 4(6.0%)with mixed-type neurosyphilis.As laboratory examination showed,67 patients all presented with positive serum rapid plasma reagin(RPR)test,serum Treponema pallidum particle agglutination(TPPA)test,and cerebrospinal fluid TPPA test,55(82.1%)had positive cerebrospinal fluid RPR test,47(70.1%)had elevated cerebrospinal fluid protein levels of>0.45 g/L,50(74.6%)had increased white blood cell counts of>8×106/L in cerebrospinal fluids,and 28(41.8%)had elevated IgG levels in cerebrospinal fluids.Magnetic resonance imaging of the brain revealed multiple ischemic foci in 21(31.3%)cases,multiple leukodystrophy in 17(25.4%),cerebral atrophy in 15(22.4%),infarction in 8(11.9%),and encephalitis-like changes in 2(3.0%).Of the 67 patients,48 were treated with penicillin in aqueous solutions,15 with ceftriaxone,and 4 with doxycycline.Six months later,the follow-up showed that 46(68.7%)patients responded to the treatment,and the early course of disease was significantly shorter in the highly responsive group than in the poorly responsive group(P<0.05).Conclusion The middle-aged and elderly males were predominant in the neurosyphilis patients with abnormal mental behaviors as the initial symptom,magnetic resonance imaging is helpful for clinical classification and prognosis prediction of neurosyphilis,and early and standardized antisyphilitic treatment can markedly improve the prognosis of patients.