神经梅毒的诊断与治疗（附23例分析）

观察神经梅毒的临床特点,以提高对神经梅毒的诊断与治疗水平。回顾性分析哈尔滨医科大学附属第一医院2005年1月至2010年12月收治的23例神经梅毒患者的临床资料。神经梅毒患者男17例（73.9%）,女6例（26.1%）,男女比约为2.8∶1;年龄27~71岁,平均年龄43.1岁。本组首发症状：麻痹性痴呆（7例）、精神异常（3例）、急性脑梗死（3例）、癫痫（2例）、脊髓病变（2例）、颅高压（2例）、周围神经损害（2例）、脑神经损害（1例）、无症状性神经梅毒（1例）。23例患者血清及脑脊液快速血浆反应素实验及梅毒螺旋体血凝试验均呈阳性反应。颅脑电子计算机断层扫描（CT）和/或磁共振成像（MRI）检查多表现为额叶、顶叶、颞叶、基底节等多发病变。本组患者经大剂量青霉素治疗后病情有显著改善20例,死亡1例,自动出院2例。神经梅毒的临床表现复杂多样,神经系统各部位均可受累,诊断依靠病史及临床表现、实验室血清及脑脊液梅毒抗体检测,误诊率高,应早期诊断,诊断后应进行规范治疗,早期治疗效果较好。

Diagnosis and Treatment of Neurosyphilis(Analysis of 23 cases Enclosed)

In order to improve diagnosis and treatment level of neurosyphilis,its clinical features were investigated.Clinical data of 23 cases neurosyphilitic patients during January 2005 through December 2010 were analyzed retrospectively.The results showed that 17 cases were male patients(73.9%),6 cases were female patients(26.1%),the ratio of male to female was 2.8∶1;among the ages of 27~71 years,at the average of 43.1.The initial symptoms of 23 neurosyphilitic patients included palsied dementia(7 cases),mental abnormality(3 cases),acute cerebral infarction(3 cases),epilepsia(2 cases),myeloid affection(2 cases),intracranial hypertension(2 cases),peripheral nerve injury(2 cases),myeloterosis(1 cases),and neurosyphilis of absent symptoms(1 cases).Rapid plasma regain(RPR) and Treponema pallidum hemagglutination assay(TPHA) tests of both serum and cerebrospinal fluid(CSF) samples from 23 patients were all positive.Computerized tomography(CT) and /or magnetic resonance imaging(MRI) examination of cranium mostly assumed multiple affections at frontal,parietal,and temporal lobes,and basal ganglia etc.After treatment with large doses of penicillin,the conditions of 20 cases in this group had significantly improved,1 case was ineffective and died,2 cases voluntarily discharged.Therefore,clinical presentation of neurosyphilis was complex and diverse,and every location of nervous system may be involved.Diagnose depended on case history and clinical manifestation,laboratory testing on serum,and CSF syphilis antibody examination might cause high rate of misdiagnose,it is recommended that the patient should be diagnosed at early phase,and should be undertaken standard treatment.Treatment at early phase had fairly good effect.