22例神经梅毒临床资料回顾性分析

发布时间：2018-04-25 01:10

本文选题：神经梅毒 + 临床表现　；参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的总结并分析宁夏地区神经梅毒患者的流行病学资料、临床表现、实验室检查及影像学表现,提高临床医师对该病的认识,争取早期诊断、早期治疗,减少漏诊、误诊。方法对2003年至2016年期间就诊于宁夏医科大学总医院及心脑血管病医院诊断为神经梅毒的22例患者病历资料进行回顾性分析,并根据2014年中国梅毒诊疗指南提出的神经梅毒诊断标准对病例资料进行再判断。结果1、本组资料中男性患者19例,女性患者3例,以中年组41-65岁居多,2009年后发病例数明显增加;2、1例患者承认冶游史,1例合并HIV感染,1例两者均有;3、临床分型中以麻痹性痴呆最多见(31.8%),其余依次为脑膜、脊髓膜血管梅毒(27.3%)、脑膜神经梅毒(22.7%)、脊髓痨(9.1%)、先天性神经梅毒(9.1%);4、22例患者均完善了血清梅毒联检,梅毒螺旋体特异性抗体检测(TPPA或TP-CLI)及梅毒螺旋体非特异性抗体检测(RPR或TRUST)均为阳性;5、脑脊液检查中颅内压5例180mm H20,占23.8%(5/21),22例患者CSF白细胞计数均≥5个/mm3,在5-330个/mm3之间,均数为37个/mm3,细胞学分类大多以淋巴细胞为主,CSF生化检查中蛋白含量均0.5g/L,在0.74-11.96g/L之间,均数为1.207g/L,葡萄糖或氯化物含量正常或稍降低;6、22例患者中2例未行脑脊液梅毒检查,1例脑脊液TPPA及TRUST检查均为阴性,其余19例患者中梅毒螺旋体特异性抗体检测(TPPA或TP-CLI)均为阳性,梅毒螺旋体非特异性抗体检测(RPR或TRUST)中5例TRUST检测为阴性,14例阳性;7、头颅影像学检查无明显特异性,可表现为急性脑梗死、脑室扩大、脑萎缩、脑膜强化、脱髓鞘改变等;8、患者在接受青霉素或头孢曲松治疗后,症状较前明显改善。结论1、神经梅毒发病率逐年增高,起病隐匿且临床表现不典型,初诊诊断率低,易被误诊。2、临床工作中应对颅内感染、认知功能减退、精神类疾病及不明原因癫痫发作、脑梗死(特别是成年人首发癫痫及青年脑梗死)等患者警惕神经梅毒的可能,必要时完善梅毒相关检查以减少漏诊、误诊。3、早期、足剂量、足疗程的抗梅毒治疗可以改善预后,应争取早期诊断、早期治疗。
[Abstract]:Objective to summarize and analyze the epidemiological data, clinical manifestations, laboratory and imaging findings of patients with neurosyphilis in Ningxia, to improve the understanding of the disease, to strive for early diagnosis, early treatment, reduce missed diagnosis and misdiagnosis. Methods the medical records of 22 patients with neurosyphilis diagnosed in the General Hospital of Ningxia Medical University and the Cardiovascular and Cerebrovascular Disease Hospital from 2003 to 2016 were retrospectively analyzed. According to the criteria of neurosyphilis diagnosis and treatment in China in 2014, the case data were rejudged. Results 1. There were 19 male and 3 female patients in this group. In the middle age group, 41-65 years old was the majority, and the number of cases increased significantly in 2009. One patient admitted to the history of HIV infection and one patient with HIV infection and one patient had 3 cases of HIV infection. In the clinical classification, palsy dementia was the most common type, and the rest was meningeal. Meningeal nerve syphilis, meningeal nerve syphilis, meningeal nerve syphilis, tuberculous phlegm, and congenital neurosyphilis, 422 patients with congenital neurosyphilis have improved the level of serum syphilis. TPPA or TP-CLI) of Treponema pallidum and non-specific antibody of Treponema pallidum were all positive. Intracranial pressure (180mm H20) was found in 5 cases of cerebrospinal fluid examination, accounting for 23.875% of 22 patients with TP-CLI. The white blood cell count of CSF in 22 patients was more than 5% mmm3, ranging from 5 to 330 / mm3. The mean value was 37 / mm ~ (-3), and most of the cytological classification was mainly lymphocytic. The protein content in the biochemical examination was 0.5g / L, between 0.74-11.96g/L, The mean value was 1.207g / L, 2 out of 22 patients with normal or slightly decreased glucose or chloride content were not tested for cerebrospinal fluid syphilis and 1 was negative for cerebrospinal fluid (CSF) TPPA and TRUST, and the other 19 patients were positive for Treponema pallidum specific antibody detection. In 5 cases of TRUST, 14 cases were positive for TRUST and 14 cases were positive for trust. There was no obvious specificity in cranial imaging examination, which could be characterized by acute cerebral infarction, ventricular enlargement, cerebral atrophy, meningeal enhancement, and no significant difference was found in the detection of Treponema pallidum (Treponema pallidum). After treatment with penicillin or ceftriaxone, the symptoms were significantly improved. Conclusion 1. The incidence of neurosyphilis is increasing year by year, the onset of neurosyphilis is hidden and the clinical manifestation is not typical, the rate of initial diagnosis is low, and it is easy to be misdiagnosed. Patients with cerebral infarction (especially adults with first-episode epilepsy and young cerebral infarction) are alert to the possibility of neurosyphilis, and improve syphilis related examination if necessary to reduce missed diagnosis, misdiagnosis, early, sufficient dosage, and sufficient course of antisyphilis treatment can improve the prognosis. We should strive for early diagnosis and treatment.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R759.13

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