伴麻痹性痴呆的神经梅毒患者的临床特征及诊断指标分析

Analysis of clinical features and diagnostic indicators of neurosyphilis patients with general paresis of insane

目的通过比较伴与不伴麻痹性痴呆(general paresis of insane,GPI)的神经梅毒患者的临床症状、实验室及影像学检查结果,分析伴GPI神经梅毒患者的临床特征,寻找可协助实现早期诊断的指标。方法纳入海军军医大学第一附属医院2010年1月1日-2021年12月31日期间收住院的104名神经梅毒患者,其中伴GPI组患者59例,不伴GPI组患者45例。收集患者人口学资料、临床表现、实验室检验结果、影像学资料进行比较分析。结果不伴GPI组与GPI组的脑脊液蛋白含量、中性粒细胞数、粒淋比(neutrophil-lymphocyte ratio,NLR)、临床表现为肢体无力的患者比例存在显著差异。并且脑脊液蛋白≥755 mg/L、NLR≥2.8,临床表现无肢体无力是神经梅毒患者伴发GPI的独立危险因素,以此构建的二元Logistic回归模型,具有较好的预测能力。结论伴GPI的神经梅毒患者常常表现为认知功能下降或(和)精神行为异常。当就诊的神经梅毒患者的NLR≥2.8,脑脊液蛋白≥755 mg/L,且临床表现症状无肢体无力时,临床医生在结合其临床症状后需警惕其合并GPI的可能,尽早进行认知功能,精神症状评估,并实施干预,有助于减缓甚至逆转神经梅毒患者的认知功能残疾的发生。

Objective To compare the clinical symptoms,laboratory and imaging results of neurosyphilis patients with and without general paresis of insane(GPI),and to analyze the clinical characteristics of patients with GPI and find the indexes that can help to realize early diagnosis.Method A total of 104 patients with neurosyphilis were admitted from the First Affiliated Hospital of Naval Medical University from January 1,2010 to December 31,2021,including 59 patients with GPI and 45 patients without GPI.The demographic data,clinical manifestations,laboratory and imaging results were collected and compared.Result There were significant differences of the cerebrospinal fluid protein,neutrophil count and neutrophil-lymphocyte ratio(NLR),the number of patients with limb weakness between these two groups.Cerebrospinal fluid protein≥755 mg/L、NLR≥2.82 and absence of limb weakness were independent risk factors of GPI,and the binary logistic regression model including the risk factors can predict GPI.Conclusion Neurosyphilis patients with GPI often show cognitive decline or/and psychiatric symptoms.NLR≥2.8,cerebrospinal fluid protein≥755 mg/L and clinical symptoms without limb weakness are predictors of GPI.When clinicians find neurosyphilis patients present with such characters,It is suggested to assess their cognitive function and mental symptoms and carry out intervention early,which is helpful to slow down or even reverse the occurrence of cognitive disability in patients with neurosyphilis.