摘要
目的探讨神经梅毒的临床特征及诊治方法。方法回顾性分析HIV阴性的33例神经梅毒患者的临床诊治相关资料。结果 33例患者包括间质性神经梅毒19例(脑膜炎型神经梅毒9例,血管型梅毒10例),实质性梅毒14例(麻痹性痴呆型10例,脊髓痨型4例),临床表现以头痛、头晕、卒中样表现、记忆力下降、精神行为异常起病多见。神经梅毒核磁共振表现多样,间质性梅毒多表现为脑梗死、脑膜强化;麻痹性痴呆多为脑萎缩、海马区异常信号。33例患者血清化学发光免疫分析法(CLIA)、甲苯胺红不加热血清试验(TRUST)、梅毒螺旋体明胶凝集试验(TPPA),以及脑脊液TRUST和TPPA检测结果均为阳性。神经梅毒脑脊液检查表现为清蛋白含量增加,白细胞增加,以单核细胞增多为主。经治疗后临床症状均缓解,随访6个月24例脑脊液蛋白和白细胞数下降,19例血清和脑脊液TRUST和TPPA转阴,脑脊液TPPA滴度明显下降,青霉素疗效明显。结论神经梅毒的临床表现多样,没有特异性,血清和脑脊液梅毒检查是诊断的重要依据,青霉素是首选的药物,脑脊液检查是疗效判断的重要手段。
Objective To analyze the clinical features of neurosyphilis,so as to help diagnosis and treatment.Methods The clinical data of 33 Human Immunodeficiency Virus（HIV）-negative patients who was confirmed with neurosyphilis were analyzed retrospectively.Results In 33 cases of neurosyphilis,19 cases were further diagnosed as cerebral interstitial syphilis,which included 9cases of meningeal syphilis and 10 cases of meningovascular syphilis.14 cases left were diagnosed as brain syphilis,including 10 cases of paralytic dementia and 4case of tabes dorsalis.These patients showed a series of symptoms such as headache,dizziness,stroke-like episodes,memory decline,and mental disorder.MRI findings of neurosyphilis were varied.Interstitial neurosyphilis had an image of cerebral infarction and enhanced meninges.General paresis had a manifestation of brain atrophy and abnormal signals of hippocampus region.Chemiluminescence immunoassay（CLIA）,Toluidine red unheated serum test（TRUST）,and treponema pallidum particle agglutination assay（TPPA）were used to diagnosed syphilis.All the serum samples of 33 patients were positive in all three tests,and the same as TRUST and TPPA in cerebrospinal fluid.The leukocytes mainly monocytes and protein concentrations of cerebrospinal fluid were increased.All patients were improved in clinical symptom after treatment.Six months after treatment,a leukocyte count and protein level of cerebrospinal fluid were decreased in 24 cases.However,TRUST and TPPA of serum and cerebrospinal fluid were negative in 19 cases.The titers of TPPA in cerebrospinal fluid decreased significantly.Penicillin treatment significantly improved clinical symptoms of neurosyphilis.Conclusion Clinical manifestations of neurosyphilis are varied and nonspecific and they aren′t specifically.Syphilis examination in serum and cerebrospinal fluid is the important basis for diagnosis.Penicillin is the drug of first choice for the treatment.Cerebrospinal fluid examination is significant indicator to monitor the effect.
出处
《检验医学与临床》
CAS
2017年第3期375-377,共3页
Laboratory Medicine and Clinic
关键词
神经梅毒
临床表现
脑脊液
血清
青霉素
neurosyphilis
clinical manifestation
cerebrospinal fluid
serum
Penicillin
