抗-HIV阴性神经梅毒患者的临床特点与实验室检测分析

Laboratory indexes detection and clinical characteristic of 20 neurosyphilis cases with anti-HIV negative

目的：分析抗-HIV阴性神经梅毒患者的临床表现、影像学检查和实验室指标检测结果，以提高对神经梅毒患者的认知和诊疗水平。方法回顾性分析2014年1月至2015年10月本院收治的20例抗-HIV阴性神经梅毒患者的临床症状、体征，影像学（MRI、CT）检查等临床资料和实验室检查结果。数据资料统计学分析采用SPSS 20.0软件。结果20例神经梅毒患者中男女比例4︰1，年龄29～78岁，平均年龄（52.6±12.4）岁。其中梅毒性脑膜炎型患者1例（5%），脑膜血管型患者8例（40%），麻痹性痴呆型患者8例（40%），脊髓痨型患者2例（10%），麻痹性痴呆合并脊髓痨型患者1例（5%）；有明确梅毒史患者6例（30%），首诊误诊率高达70%。所有患者梅毒血清学检测梅毒螺旋体明胶颗粒凝集试验（TPPA）和快速血浆反应素（RPR）均为阳性（1：2～1：128），脑脊液TPPA均阳性，RPR阳性17例（85%）（1：2～1：16）。脑脊液白细胞＞10×106/L患者18例（90%），均为单核细胞升高；蛋白升高患者17例（85%），葡萄糖异常患者15例（75%），氯化物水平和脑脊液压力均正常；17例行脑脊液IgG检测16例患者升高（94.12%）；15例患者脑脊液IgG寡克隆带检测13例阳性（86.67%）；13例患者中CSF-24 h IgG合成率升高者12例（92.31%）。各临床型患者脑脊液实验室检测结果差异无统计学意义（χ2=1.63、P =0.95）。结论神经梅毒以壮年男性多见，临床表现多样，是易误诊的可治性疾病，血清及脑脊液梅毒检查对指导早期诊疗和预后具有重要价值。

Objective To investigate the clinical characteristics and results of laboratory indexes detection of neurosyphilis with anti-HIV negative, and to improve the diagnosis and treatment level of neurosyphilis.Methods The clinical symptoms and laboratory characteristic (including imaging of MRI, CT) of 20 cases of neurosyphilis with anti-HIV negative were analyzed, retrospectively, in Xuanwu Hospital of Capital Medical University from January 2014 to October 2015. All the data were analyzed by SPSS 20.0 software.Results There were 4 females and 16 males with adult neurosyphilis of anti-HIV-negative, with the average age of (52.6 ± 12.4) years old (29-78 years old). There were 1 case (5%) with syphilitic meningitis, 8 cases (40%) with menigeal vascular type syphilis, 8 cases (40%) with paralytic dementia, 2 cases (10%) with tabes dorsalis, and 1 case (5%) with paralytic dementia and tabes dorsalis. There were 6 cases (30%) with clear history of syphilis and the misdiagnosed rate was 70%. Serum treponema pallidum particle assay (TPPA) and rapid plasma regain (RPR) were positive in 20 cases (1:2-1:128). The CSF-TPPA were positive in all patients, while 17 cases (85%) with CSF-RPR positive were as 1:2-1:16. The concentration of white blood cell (WBC) in CSF were abnormal (> 10 × 106/L) in 18 cases (90%). The CSF-protein increased in 17 cases (85%) and CSF-glucose were abnormal in 15 cases (75%). The positive rates of CSF-IgG, oligoclonal band (OB) and 24 h-CSF IgG were 94.12% (15/17), 86.67% (13/15) and 92.31% (12/13), respectively. The results of CSF detected in different clinical types were not signiifcant (χ2= 1.63,P = 0.95).Conclusions The clinical manifestations of neurosyphilis were complicated and easily misdiagnosed, and mainly occurs among young males. The detailed history, serum and cerebrospinal lfuid examination could guide early diagnosis and treatment, and get better prognosis for suspected cases.