神经梅毒18例诊治分析并文献复习

Neuro-syphilis diagnosis and treatment of 18 cases and literature review

目的通过分析神经梅毒(NS)的临床特点,为其早期诊断提供依据。方法回顾性分析山西省2家医院(2所均为省级三甲综合医院,其中1所为教学医院,1所为非教学医院)共18例NS,并结合文献对NS首发症状、实验室检查、治疗及疗效进行分析。结果 18例NS除了5种主要类型的NS,即无症状型NS、脑脊膜梅毒、脑膜血管梅毒、脑实质梅毒(麻痹性痴呆和脊髓结核)和树胶样肿性NS以外,还可以脑出血、癫痫、精神症状、言语行为异常等非典型症状首发;非教学医院9例,其中1例未做腰穿,3例未查脑脊液(CSF)性病系列,并不符合诊断标准;教学医院9例,均检查了CSF系列;2周疗程结束后患者症状均有不同程度好转,其中3例复查CSF,2例白细胞数及蛋白数降至正常,1例无变化,3例RPR滴度均下降1个滴度。余患者未复查CSF。结论 NS临床表现多样,特异性症状少,在临床工作中极易被漏诊及误诊,血清及CSF梅毒筛选及确诊试验是诊断梅毒的关键环节,2所医院虽均为省级三甲医院,但教学医院比非教学医院在诊断NS时更具规范性。因此提高对NS的认识及规范化的实验室检查及诊疗是早期诊断NS并降低并发症的关键措施。青霉素仍是驱梅治疗的首选药物。

Objective We can provide the basis for early diagnosis of neurosyphilis(NS) through the analysis of it’s the clinical features. Methods Retrospective analysis of 18 cases of patients with NS in two hospitals of Shanxi province(The two hospitals are all provincial grade three general hospital. One for teaching hospitals, the other for non-teaching hospital), and analyzing the first symptoms, laboratory examinations, treatment and remission with review of the literature. Results In addition to 5 major types of NS, namely asymptomatic-NS, meningeal syphilis, meningovascular syphilis, brain syphilis(paresis and Tabes dorsalis) and Gumma-NS, NS also included atypical symptoms of cerebral hemorrhage, seizures, psychotic symptoms and so on. Non-teaching hospitals in 9 cases, of which 4 cases did not meet the diagnosis criteria: one case didn’t undergo umbar puncture, three cases weren’t identified in cerebrospinal fluid(CSF) STD series. 9 cases in teaching hospitals were all examined in CSF series. After the treatment of 2 weeks, patients improved symptoms to a different degree, 3 cases were reviewed CSF, 2 cases of white blood cells and protein count returned to normal, 1 showed no change, 3 cases of RPR titers declined titer of 1. Remaining patients did not review the CSF. Conclusions The clinical manifestations of NS is of a wide variety, and there is less specific symptoms, it can easily be missed diagnosis and misdiagnosis in clinical work. Therefore serum and cerebrospinal fluid in screening and confirmatory test for syphilis is the key to diagnose syphilis. Although two hospitals are provincial hospitals, teaching hospital is more prescriptive than non-teaching hospitals of diagnosis of NS. Raising awareness of the NS and standardization of laboratory testing and treatment is critical for early diagnosis and reducing the complications of measures. Penicillin is still the drug of choice for syphilis treatment.