53例神经梅毒患者临床特点分析

发布时间：2018-04-10 13:03

本文选题：神经梅毒 + 梅毒螺旋体　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:分析2000年-2016年于青岛大学附属医院及中山大学一附院住院治疗的53例神经梅毒患者的临床特点,为临床医生提供参考。方法:参考2010年美国疾病控制中心(Centers for Disease Control and Prevention,CDC)神经梅毒诊断标准,回顾分析2000年-2016年于青岛大学附属医院及中山大学一附院住院治疗的53例神经梅毒患者的临床资料,包括患者性别、年龄、冶游史等病史情况,也包括神经梅毒患者的临床症状与体征、实验室检查、影像学检查结果。结果:(1)共有53例患者符合入组标准,包括46例男性及7例女性,除了一例为越南人外,均为中国人。发病年龄范围为20岁-80岁(平均发病年龄为48.51岁)。(2)最常见的临床类型是脑膜血管型神经梅毒(35.85%),其次是麻痹性痴呆(28.30%),脑膜型神经梅毒(11.32%)、脊髓痨(7.55%)、梅毒性脊髓脊膜炎(9.43%)、无症状神经梅毒(7.55%)。最常见的首发症状为肢体乏力(34%)。(3)入组神经梅毒患者进行了血清梅毒螺旋体明胶颗粒凝集试验(treponema pallidum particleagglutination,TPPA)检查及血清人类免疫缺陷病毒(human immunodeficiency virus,HIV)抗体检查,53例患者均为血清TPPA阳性及HIV阴性。53例神经梅毒患者进行了脑脊液(Cerebrospinal Fluid,CSF)常规检查,20例出现CSF白细胞升高,出现33例CSF蛋白升高,同时出现CSF白细胞升高及蛋白升高者19例;(4)40例神经梅毒患者行颅脑颅脑核磁共振检查磁共振成像(Nuclear Magnetic Resonance Imaging,MRI)其中7例颅脑MRI无异常表现,33例神经梅毒患者(包括脑膜型神经梅毒1例脊髓脊膜型神经梅毒3例脑膜血管型神经梅毒17例麻痹性痴呆11例脊髓痨1例)颅脑MRI出现异常表现,包括卒中样表现、脑萎缩表现及白质异常信号等,最主要的影像学改变为梗死灶改变,共有20例。5例神经梅毒患者进行了脑电图检查,2例出现异常的脑电图改变,一例表现为癫痫样放电,一例表现为背景慢波活动,2名患者均为麻痹性痴呆患者。结论:1.53例神经梅毒患者中,最常见的神经梅毒临床分型为脑膜血管型神经梅毒,临床模式已出现明显改变。2.53例神经梅毒患者中出现了较多的漏诊、误诊现象,血清学检查、脑脊液检查、影像学检查均无特异性。临床诊断神经梅毒时,需综合流行病学、临床表现、实验室检查及影像学检查进行综合判断。3.每个具有神经精神症状但没有明确原因的患者均应进行梅毒血清学检查。当梅毒血清学检查阳性时,患者应进行脑脊液检查,以免漏诊、误诊,影响预后。
[Abstract]:Objective: to analyze the clinical characteristics of 53 cases of neurosyphilis hospitalized in affiliated Hospital of Qingdao University and the first affiliated Hospital of Sun Yat-sen University from 2000 to 2016 so as to provide reference for clinicians.Methods: the clinical data of 53 neurosyphilis patients who were hospitalized in Qingdao University affiliated Hospital and Sun Yat-sen University first affiliated Hospital from 2000 to 2016 were retrospectively analyzed with reference to the criteria for diagnosis of neurosyphilis by Centers for Disease Control and PreventionCDCin 2010.It includes patient's gender, age, history of travel, clinical symptoms and signs of neurosyphilis, laboratory examination and imaging results.Results A total of 53 patients, including 46 males and 7 females, were all Chinese except one Vietnamese.9.43% and 7.55% of asymptomatic neurosyphilis.The most common initial symptom was limb asthenia 34. The patients with neurosyphilis were examined by serum treponema pallidum particle agglutination test and serum human immunodeficiency virus immunodeficiency virus) antibody test. 53 patients were all blood samples from the patients with neurosyphilis who were treated with treponema pallidum particle agglutination test (TPPA) and human immunodeficiency virus virus virus (HIV) antibody test.Serum TPPA positive and HIV negative. 53 patients with neurosyphilis were examined with Cerebrospinal fluid fluid (CSF) in 20 cases with CSF leukocytosis.CSF protein increased in 33 cases.CSF leucocyte and protein were increased in 19 patients with neurosyphilis and 40 patients with neurosyphilis were examined by magnetic resonance imaging (MRI), 7 of them had no abnormal manifestations of MRI in the brain (including 33 patients with neurosyphilis).1 case of membranous neurosyphilis 1 case of spinal meningeal neurosyphilis 3 cases of meningeal vascular type neurosyphilis 17 cases of paralytic dementia 11 cases of tuberculosis) craniocerebral MRI abnormal manifestation.Including apoplexy, cerebral atrophy and abnormal white matter signals, the most important imaging changes were infarction. A total of 20 patients with neurosyphilis underwent electroencephalogram (EEG) examination, 2 of them showed abnormal EEG changes.One case showed epileptiform discharge and one case showed background slow wave activity. Two patients were all paralytic dementia.Conclusion among 1.53 patients with neurosyphilis, the most common type of neurosyphilis is meningeal vascular neurosyphilis.Cerebrospinal fluid examination and imaging examination were not specific.In clinical diagnosis of neurosyphilis, comprehensive epidemiological, clinical manifestations, laboratory examination and imaging examination are needed to make a comprehensive judgment. 3.Syphilis serology should be performed on every patient with neuropsychiatric symptoms but no definite cause.When syphilis serological examination is positive, the patient should have cerebrospinal fluid examination to avoid missed diagnosis, misdiagnosis and influence prognosis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R759.13

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