54例神经梅毒临床特征分析
发布时间：2018-07-15 10:57
【摘要】：目的:神经梅毒(neurosyphilis,NS)系由苍白密梅毒螺旋体(treponema pallidum,TP)侵入人体神经系统以后,出现的脑脊膜、血管或脑脊髓实质损害的一组临床综合征,是晚期(III期)梅毒全身性损害的重要表现。近年来梅毒在全世界范围内增长迅速,合并HIV感染的患病人群大量增加。梅毒的临床表现复杂多样,被称为“最杰出的模仿者”,目前尚无诊断金标准,早期规范抗生素治疗有效,而未经治疗者晚期阶段致残率和致死率高。本文总结54例神经梅毒患者的临床特征及诊治要点,以期提高该病的早期诊断和治疗水平。材料与方法:本研究参照美国疾病控制中心2010年神经梅毒诊断标准,收集大连医科大学附属第一医院及大连市皮肤病医院自2010年6月至2015年7月诊治的神经梅毒患者共54例,回顾性分析一般资料、病史资料、神经系统体格检查、实验室检查、影像学检查、诊疗经过及预后,进行临床分型,总结了神经梅毒的临床特征、影像学特点及诊治要点。结果:(1)54例神经梅毒患者,男34例,女20例,年龄为24岁至77岁(平均48.1±14.4岁),9例存在梅毒感染史,10例患者承认存在冶游史,2例患者合并HIV感染,3例已婚患者配偶存在梅毒感染史。明确冶游史患者中,发病最短者为接触史半年,最长者为接触史44年。患者职业分布中无业人员所占比例最大(72.1%),婚姻状况以已婚人员所占比例最大(85.2%)。(2)临床分型:无症状型神经梅毒37例(68.5%),无明确神经系统症状及定位体征,3例存在阿-罗瞳孔;脑膜神经梅毒4例(7.4%),主要表现为发热、头痛、颈项强直,视物模糊,耳鸣、耳聋,结膜充血;脑膜、脊髓膜血管梅毒2例(3.7%),主要表现为头晕、头痛,偏瘫、肢体麻木无力,不完全运动型失语;脊髓痨2例(3.7%),主要表现为发热,肢体麻木无力,尿便障碍;麻痹性神经梅毒9例(16.7%),主要表现为认知障碍,精神行为异常,言语障碍,动作笨拙、肢体震颤,痫性发作,阿-罗瞳孔,卒中样表现。(3)54例患者血清梅毒螺旋体明胶凝集试验(treponema pallidum agglutination assay,TPHA)均阳性,快速血浆反应素试验(rapid plasma reagin,RPR)介于1:4~1:64。51例患者行腰椎穿刺术采集脑脊液(Cerebrospinal fluid,CSF)行TPHA,均为阳性,RPR介于1:1~1:16,其中6例麻痹性神经梅毒患者的CSF白细胞数和蛋白含量增高,异常比例100%。(4)影像学检查发现3例脑膜神经梅毒患者头MRI表现为小片状或点状长T1长T2信号,位于单侧或双侧颞叶,额叶强化病灶;1例脑膜脊髓膜血管梅毒头MRI表现为轻度脑白质脱髓鞘改变,基底节区低密度灶;1例脊髓痨患者颈椎MRI表现为C5水平髓内片状长T1长T2信号灶,1例未见明显异常;9例麻痹性神经梅毒患者头MRI主要表现为严重脱髓鞘改变,额叶颞叶多发缺血灶及不同程度脑萎缩,伴有脑室系统扩大、脑积水。(5)51例患者行规范化驱梅治疗,“治愈”患者人数41例(占80.4%),无效4例(7.8%),失访6例(11.8%);重启治疗患者5例(9.8%),其中3例(5.8%)再次治疗有效,治疗失败2例(3.9%);合并HIV感染的2例(3.9%)治疗不佳。结论:1.神经梅毒患者男性多于女性,平均发病年龄48.1±14.4岁,具有冶游史、梅毒感染史、HIV感染和配偶存在梅毒感染是神经梅毒发生的高危人群。2.TP可在接触感染后半年至44年侵及神经系统,故临床应注意对梅毒患者尽早行神经梅毒筛查。3.临床中神经梅毒分为无症状型神经梅毒、脑膜神经梅毒、脑膜脊髓膜血管梅毒、脊髓痨及麻痹性神经梅毒五种类型,其中无症状型神经梅毒患者人数最多(37例,占68.5%),麻痹性神经梅毒次之(9例,占16.7%)。4.常规行血清TPHA检测可发现梅毒患者,对有神经系统症状或无症状但监测血清RPR持续不降的梅毒患者需腰穿行CSF TPHA和RPR检测,有助于确诊神经梅毒;麻痹性神经梅毒患者CSF白细胞数和蛋白含量均升高,可以协助诊断麻痹性神经梅毒。5.神经梅毒患者磁共振表现复杂、无特异性。6.早期规范化驱梅治疗治疗可较好的改善神经梅毒的临床预后。
[Abstract]:Objective: neurosyphilis (NS) is a group of clinical syndromes of the brain spinal meninges, blood vessels, or brain and spinal parenchyma after the intrusion of Treponema pallidum (TP) to the human nervous system. It is an important manifestation of systemic damage in the late (III phase) syphilis. The prevalence of HIV infection has increased in large numbers. The clinical manifestations of syphilis are complex and diverse, which are called "the most outstanding imitators". There is no diagnostic gold standard, early standard antibiotic treatment is effective, and the untreated patients have high mortality and disability in the late stage. The clinical features and diagnosis and treatment points of 54 patients with neurosyphilis are summarized in this paper. In order to improve the early diagnosis and treatment level of the disease. Materials and methods: in this study, 54 cases of neuromei patients were collected from June 2010 to July 2015 from the First Affiliated Hospital of Dalian Medical University and Dalian City Dermatology Hospital with reference to the diagnostic standard of neurosyphilis in 2010, and the general data were analyzed retrospectively. Medical history, nervous system physical examination, laboratory examination, imaging examination, diagnosis and treatment and prognosis, clinical classification, summarized the clinical features of neurosyphilis, imaging features and diagnosis and treatment points. Results: (1) 54 cases of neurosyphilis, 34 men, 20 cases, age from 24 to 77 years (mean 48.1 + 14.4 years), 9 cases of syphilis infection History, 10 patients admitted the existence of history of travel, 2 patients with HIV infection, 3 married couples had a history of syphilis infection. The shortest incidence was the history of contact history for half a year, the longest was 44 years of contact history. The proportion of unemployed persons in the occupational distribution was the largest (72.1%), and the proportion of married people was the largest (8 5.2%) (2) clinical classification: 37 cases of asymptomatic neurosyphilis (68.5%), no definite nervous system symptoms and positioning signs, 3 cases of opioid pupil, 4 cases of meningeal neurosyphilis (7.4%), mainly characterized by fever, headache, neck rigidity, blurred visual substance, tinnitus, hearing loss, conjunctival congestion, and 2 cases (3.7%) of meninges and spinal meningeal syphilis (3.7%), mainly manifested dizziness, Headache, hemiplegia, numbness and weakness of limbs, incomplete motor aphasia, 2 cases of tuberculosis (3.7%), mainly manifested as fever, numbness and weakness of the limbs, urinary disorders, 9 cases of paralytic neurosyphilis (16.7%), mainly manifested as cognitive impairment, abnormal mental behavior, speech disorder, clumsy movement, limb tremor, epileptic seizures, opioid pupil, apoplexy appearance. (3) 54 Patients with serum Treponema pallidum gelatin agglutination test (Treponema pallidum agglutination assay, TPHA) were both positive, and the rapid plasma reacin test (rapid plasma reagin, RPR) was in 1:4~1:64.51 patients with lumbar puncture and collected cerebrospinal fluid (Cerebrospinal fluid), both were positive, and 6 cases were paralyzed. The number and protein content of CSF in patients with neurosyphilis increased, and the abnormal proportion of 100%. (4) imaging findings found that the head MRI of 3 cases of meningeal neurosyphilis showed small slice or long T1 long T2 signal, located in unilateral or bilateral temporal lobe and frontal lobe, and 1 cases of meningospinal vascular syphilis MRI showed mild white matter demyelination. The MRI manifestations of cervical vertebrae in 1 cases were C5 level and long T1 long T2 signal of intramedullary slice and long T1 long T2 signal. The head MRI of the 9 cases of paralytic neurosyphilis was mainly characterized by severe demyelination, multiple focal cerebral ischemia in the frontal and temporal lobe and different degrees of brain atrophy, with ventricle system enlargement and hydrocephalus (5) 51 cases. There were 41 cases of "cured" patients (80.4%), 4 cases (7.8%), 6 cases (11.8%), 5 cases (9.8%) restarted, 3 cases (5.8%), 2 (3.9%), and 2 cases (3.9%) with HIV infection. Conclusion: more men than women, average age of onset of neurosyphilis. 8.1 + 14.4 years old, with history of swimming, history of syphilis infection, HIV infection and syphilis infection in spouses is a high risk group for neurosyphilis,.2.TP can invade the nervous system for six months to 44 years after contact infection. Therefore, the clinical attention should be paid to the early neurosyphilis screening for syphilis patients in.3. clinical neurosyphilis divided into asymptomatic neurosyphilis, meninges Five types of neurosyphilis, meningospinal vascular syphilis, tuberculosis and paralytic neurosyphilis, among which, the number of asymptomatic neurosyphilis (37 cases, 68.5%), paralytic neurosyphilis (9 cases, 16.7%).4. routine serum TPHA detection can be found in the patients with the symptoms of nervous system or asymptomatic but monitoring serum RPR Patients with persistent syphilis should be tested with CSF TPHA and RPR for diagnosis of neurosyphilis. The number and protein content of CSF in patients with paralytic neurosyphilis are increased, which can help diagnose the complex magnetic resonance of the patients with.5. neurosyphilis of paralytic neurosyphilis, and the treatment of early standardized.6. for the treatment of the paralytic neurosyphilis is better. To improve the clinical prognosis of neurosyphilis.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R759.13
本文编号：2123839
[Abstract]:Objective: neurosyphilis (NS) is a group of clinical syndromes of the brain spinal meninges, blood vessels, or brain and spinal parenchyma after the intrusion of Treponema pallidum (TP) to the human nervous system. It is an important manifestation of systemic damage in the late (III phase) syphilis. The prevalence of HIV infection has increased in large numbers. The clinical manifestations of syphilis are complex and diverse, which are called "the most outstanding imitators". There is no diagnostic gold standard, early standard antibiotic treatment is effective, and the untreated patients have high mortality and disability in the late stage. The clinical features and diagnosis and treatment points of 54 patients with neurosyphilis are summarized in this paper. In order to improve the early diagnosis and treatment level of the disease. Materials and methods: in this study, 54 cases of neuromei patients were collected from June 2010 to July 2015 from the First Affiliated Hospital of Dalian Medical University and Dalian City Dermatology Hospital with reference to the diagnostic standard of neurosyphilis in 2010, and the general data were analyzed retrospectively. Medical history, nervous system physical examination, laboratory examination, imaging examination, diagnosis and treatment and prognosis, clinical classification, summarized the clinical features of neurosyphilis, imaging features and diagnosis and treatment points. Results: (1) 54 cases of neurosyphilis, 34 men, 20 cases, age from 24 to 77 years (mean 48.1 + 14.4 years), 9 cases of syphilis infection History, 10 patients admitted the existence of history of travel, 2 patients with HIV infection, 3 married couples had a history of syphilis infection. The shortest incidence was the history of contact history for half a year, the longest was 44 years of contact history. The proportion of unemployed persons in the occupational distribution was the largest (72.1%), and the proportion of married people was the largest (8 5.2%) (2) clinical classification: 37 cases of asymptomatic neurosyphilis (68.5%), no definite nervous system symptoms and positioning signs, 3 cases of opioid pupil, 4 cases of meningeal neurosyphilis (7.4%), mainly characterized by fever, headache, neck rigidity, blurred visual substance, tinnitus, hearing loss, conjunctival congestion, and 2 cases (3.7%) of meninges and spinal meningeal syphilis (3.7%), mainly manifested dizziness, Headache, hemiplegia, numbness and weakness of limbs, incomplete motor aphasia, 2 cases of tuberculosis (3.7%), mainly manifested as fever, numbness and weakness of the limbs, urinary disorders, 9 cases of paralytic neurosyphilis (16.7%), mainly manifested as cognitive impairment, abnormal mental behavior, speech disorder, clumsy movement, limb tremor, epileptic seizures, opioid pupil, apoplexy appearance. (3) 54 Patients with serum Treponema pallidum gelatin agglutination test (Treponema pallidum agglutination assay, TPHA) were both positive, and the rapid plasma reacin test (rapid plasma reagin, RPR) was in 1:4~1:64.51 patients with lumbar puncture and collected cerebrospinal fluid (Cerebrospinal fluid), both were positive, and 6 cases were paralyzed. The number and protein content of CSF in patients with neurosyphilis increased, and the abnormal proportion of 100%. (4) imaging findings found that the head MRI of 3 cases of meningeal neurosyphilis showed small slice or long T1 long T2 signal, located in unilateral or bilateral temporal lobe and frontal lobe, and 1 cases of meningospinal vascular syphilis MRI showed mild white matter demyelination. The MRI manifestations of cervical vertebrae in 1 cases were C5 level and long T1 long T2 signal of intramedullary slice and long T1 long T2 signal. The head MRI of the 9 cases of paralytic neurosyphilis was mainly characterized by severe demyelination, multiple focal cerebral ischemia in the frontal and temporal lobe and different degrees of brain atrophy, with ventricle system enlargement and hydrocephalus (5) 51 cases. There were 41 cases of "cured" patients (80.4%), 4 cases (7.8%), 6 cases (11.8%), 5 cases (9.8%) restarted, 3 cases (5.8%), 2 (3.9%), and 2 cases (3.9%) with HIV infection. Conclusion: more men than women, average age of onset of neurosyphilis. 8.1 + 14.4 years old, with history of swimming, history of syphilis infection, HIV infection and syphilis infection in spouses is a high risk group for neurosyphilis,.2.TP can invade the nervous system for six months to 44 years after contact infection. Therefore, the clinical attention should be paid to the early neurosyphilis screening for syphilis patients in.3. clinical neurosyphilis divided into asymptomatic neurosyphilis, meninges Five types of neurosyphilis, meningospinal vascular syphilis, tuberculosis and paralytic neurosyphilis, among which, the number of asymptomatic neurosyphilis (37 cases, 68.5%), paralytic neurosyphilis (9 cases, 16.7%).4. routine serum TPHA detection can be found in the patients with the symptoms of nervous system or asymptomatic but monitoring serum RPR Patients with persistent syphilis should be tested with CSF TPHA and RPR for diagnosis of neurosyphilis. The number and protein content of CSF in patients with paralytic neurosyphilis are increased, which can help diagnose the complex magnetic resonance of the patients with.5. neurosyphilis of paralytic neurosyphilis, and the treatment of early standardized.6. for the treatment of the paralytic neurosyphilis is better. To improve the clinical prognosis of neurosyphilis.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R759.13
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