13例HIV阴性神经梅毒患者临床特征分析

Clinical and Laboratory Characteristics of Neurosyphilis in 13 HIV-Negative Patients

目的:总结分析近年来东营地区人免疫缺陷病毒(human immunodeficiency virus, HIV)阴性神经梅毒(neurosyphilis, NS)患者的临床特点、实验室检查和影像学资料,提高临床医师对神经梅毒的认识和诊疗水平,减少漏诊、误诊。方法:对2012年至2021年就诊于胜利油田中心医院神经内科并诊断为HIV阴性神经梅毒的17例患者的临床资料进行筛选和回顾性分析,并依据《梅毒、淋病和生殖道沙眼衣原体感染诊疗指南(2020年)》对病例资料进行再分析。结果:共有17例患者拟诊神经梅毒,其中确诊13例且临床资料完整,年龄26~88岁,9例为男性。临床分型中,脑实质梅毒8例(61.54%),脑膜血管梅毒3例(23.08%),脑脊膜神经梅毒1例(7.69%),无症状神经梅毒1例。临床症状以认知障碍与精神行为异常最多见。脑脊液白细胞数、蛋白水平不同程度升高。血清及脑脊液梅毒螺旋体明胶颗粒凝集试验(treponema pallidum particle agglutination assay, TPPA)和梅毒甲苯胺红不加热血清试验(toluidine red unheated serum test, TRUST)均为阳性。在接受青霉素或头孢曲松治疗后症状好转。结论:神经梅毒临床表现与影像学表现缺乏特异性,临床工作中应对不明原因的认知障碍及精神行为异常患者做进一步鉴别,减少误诊。Object: To summarize and analyze the clinical characteristics of neurosyphilis (NS) in HIV-negative patients, improving identification of NS by clinical practitioners and reducing missed diagnosis and misdiagnosis. Methods: We retrospectively screened the data of HIV-negative NS patients who were presented in Shengli Oilfield Hospital, and analyzed these information based on Guidelines for Infection of Neurosyphilis, Chlamydia trachomatis and Neisseria tonorrhoeae. Results: There were 17 patients diagnosed as NS, of which 13 were confirmed with complete clinical data, aged from 26 to 88 years old, and 9 patients were male. There were 8 cases of cerebral syphilis (61.54%), 3 cases of meningovascular syphilis (23.08%), 1 case of meningeal neurosyphilis (7.69%) and 1 case of asymptomatic neurosyphilis. Cognitive impairment and psychiatric symptoms were prominent symptoms. We observed increased proteins and white blood cell levels in these patients’ cerebrospinal fluid (CSF). Treponema pallidum particle agglutination assay (TPPA) and toluidine red unheated serum test (TRUST) of serum and CSF in all patients showed positive. Symptoms improved after treatment with penicillin or ceftriaxone. Conclusion: The clinical presentation and radiological appearance in NS patients were lack of specificity. Practitioners should take further differential diagnosis for cases with unexplained cognitive impairment and psychiatric symptoms to reduce misdiagnosis.