神经梅毒18例诊治分析并文献复习

发布时间：2018-07-20 15:10

【摘要】：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。
[Abstract]:Objective to analyze the clinical features of neurosyphilis (NS) and to provide evidence for its early diagnosis. Methods A retrospective analysis of 18 cases of NSs in 2 hospitals (2 provincial hospitals, 1 teaching hospital and 1 non-teaching hospital) in Shanxi Province was performed. The first symptom, laboratory examination, treatment and curative effect of NS were analyzed in combination with literature. Results in addition to 5 main types of NSs, including asymptomatic NSs, meningeal syphilis, meningeal vascular syphilis, cerebral parenchyma syphilis (paralytic dementia and spinal cord tuberculosis) and gum like swelling NS, 18 cases of NS could also have cerebral hemorrhage, epilepsy, and mental symptoms. There were 9 cases in non-teaching hospital, 1 case without lumbar puncture, 3 cases without cerebrospinal fluid (CSF) venereal disease series, 9 cases in teaching hospital, 9 cases in non-teaching hospital. The symptoms of all patients were improved in varying degrees after the end of 2 weeks of CSF treatment. In 3 cases, the leukocyte count and protein count of 2 cases with CSFU decreased to normal in 1 case, and the RPR titer of 3 cases decreased by 1 titer. CSF was not reexamined in other patients. Conclusion NS has various clinical manifestations and few specific symptoms. It is easy to be missed and misdiagnosed in clinical work. The screening and diagnosis of syphilis in serum and CSF are the key links in the diagnosis of syphilis. But the teaching hospital is more normative than the non-teaching hospital in the diagnosis of NS. Therefore, to improve the understanding of NS and standardized laboratory examination and diagnosis and treatment is the key to early diagnosis of NS and reduce complications. Penicillin is still the first choice in the treatment of plum.
【作者单位】：山西医科大学第二医院皮肤性病科;山西省人民医院神经内科;
【基金】：山西省软科学研究项目(2011041073-02)
【分类号】：R759.13

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