神经梅毒3例及文献复习

目的:总结神经梅毒的临床特点及诊断.方法 :通过收集3例神经梅毒的临床资料,并检索中国生物医学文献、维普、万方等数据库1994-2014年在核心期刊公开发表的关于神经梅毒文献进行回顾分析.结果 :纳入133篇,1208例病人(不包含本文3例),男971例(80.38%),女237例(19.62%),男女比例4:1;年龄15~80岁,60岁以上126例(10.43%).有冶游史(包括配偶)634例(52.48%),合并人类免疫缺陷病毒阳性16例(1.32%),误诊635例(52.57%).临床分型包括无症状型80例(6.62%),脑(脊)膜型149例(12.33%),脑(脊)膜血管型389例(32.20%),麻痹性痴呆457例(37.83%),脊髓痨94例(7.78%),树胶样肿16例(1.32%),混合型22例(1.82%),特殊类型(腓总神经梅毒)1例(0.08%).结论 :神经梅毒多发于青中年男性,临床表现多样,误诊率高,诊断主要靠血清学、脑脊液检查,影像学及电生理检查等无特异性.

Clinical analysis of neurosyphilis in 3 cases and the literature review

Objective:To summarize the clinical characteristics and diagnosis of neurosyphilis. Methods:The clinical data of 3 patients with neurosyphilis were retrospectively analyzed. The literatures about neurosyphilis from in CNKI,VIP and Wanfang database were searched,and these literatures were published in Chinese Sci-tech Core Periodicals from 1994 to 2014. Results:One hundred and thirty-three literatures(1208 patients) were identified,1028 patients(without 3 patients in this article) included 971 male cases (80. 38%) and 237 female cases (19. 62%) and the ratio of male to female was 4:1. The patients age was from 15 to 80 years old, and the patients over 60 years old was 126 cases(10. 43%). The patients with play history(including spouse) in 634 cases (52.48%),HIV infection in 16 cases(1. 32%),and misdiagnosis in 635 cases(52. 57%) were found. The asymptomatic type neurosyphilis in 80 cases(6. 62%),meningeal(spinal) type neurosyphilis in 149 cases(12. 33%),meningovascular(spinal) type neurosyphilis in 389 cases(32. 20%),paralytic dementia in 457 cases(37. 83%),tabesdorsalis in 94 cases(7. 78%),syphilitic gumma in 16 cases(1.32%),mixed type in 22 cases(1. 82%) and special type(common peroneal nerve neurosyphilis) in 1 case (0. 08%) were identified. Conclusions:Neurosyphilis is often found in young and middle-aged men with various clinical manifestations and high misdiagnosis rate, which can mainly be diagnosed by serum and cerebrospinal fluid examination. The imaging and electrophysiological examinations are not specific.