神经梅毒50例住院患者临床分析

Clinical analysis of 50 inpatients with neurosyphilis

目的 探讨有症状性神经梅毒患者的临床特征。方法 对2019年2月至2021年5月年就诊于南京市第二医院的50例年龄为(58.16±10.36)岁、男性占84.00%的有症状性神经梅毒住院患者的临床资料进行回顾性分析。按颅脑磁共振成像(MRI)结果将其分为MRI双侧异常组(n=25)及MRI正常/单侧异常组(n=25),进行组间比较。结果 神经梅毒临床分类为脑实质型33例(66.00%),脑膜血管型11例(22.00%),脊髓型4例(8.00%),脑炎、脑膜炎型2例(4.00%);脑脊液(CSF)甲苯胺红血清不加热试验(TRUST)阳性42例(84.00%);脑脊液-梅毒螺旋体明胶颗粒凝集实验(CSF-TPPA)全部50例均阳性。与颅脑MRI正常/单侧异常组相比,双侧MRI异常组年龄较大(t=2.798,P=0.007)、伴发基础疾病比例较高(48.00%vs 20.00%,χ^(2)=4.367,P=0.037),CSF蛋白定量较高(t=2.130,P=0.038),差异有统计学意义;但两组CSF白细胞计数及TRUST滴度差异无统计学意义(P>0.05)。结论 神经梅毒临床表现多变,诊断需综合临床症状、CSF检查和影像学检查进行判断;年长患者及伴基础疾病患者有影像学异常提示病情偏重,因此对此两类人群需格外关注;另外梅毒应成为脑血管病变的危险因子;及时降低CSF蛋白浓度可能改善神经梅毒患者的预后。

Objective To explore the clinical characteristics of inpatients with symptomatic neurosyphilis.Methods A retrospective study was conducted on the clinical data from 50 symptomatic neurosyphilis inpatients,aged(58.16±10.36)years and 84.00%male,who were admitted to the Department of Neurology,the Second Hospital of Nanjing from February 2019 to May 2021.According to the results of brain magnetic resonance imaging(MRI),inpatients were divided into MRI bilateral abnormal group(n=25)and MRI normal/unilateral abnormal group(n=25)for intergroup comparison.Results There were 33 cases of parenchymal type of neurosyphilis,11 cases of meningovascular type,4 cases of myelopathic type,and 2 cases of meningeal meningitis type,accounting for 66.00%,22.00%,8.00%and 4.00%respectively.Forty-two cases were positive for toluidine red unheated serum test(TRUST)in cerebrospinal fluid(CSF),accounting for 84.00%.All 50 cases were positive for treponema pallidum particle assay(TPPA)in CSF.Compared with MRI normal or unilateral abnormal group,the patients in MRI bilateral abnormal group had a older age(t=2.798,P=0.007),a higher proportion of underlying diseases(48.00%vs 20.00%,χ^(2)=4.367,P=0.037),and a higher quantification of CSF protein(t=2.130,P=0.038),all with statistical differences.Conclusion The clinical manifestations of neurosyphilis are variable,and diagnosis of neurosyphilis should be based on clinical manifestations,CSF and imaging examination.The imaging findings of elderly patients and patients with underlying diseases predict that the disease are more severe,so special attention should be paid to the patients mentioned above.In addition,neurosyphilis should be as a risk factor for cerebrovascular disease.Timely reducing CSF protein levels may improve the prognosis of patients with neurosyphilis.