麻痹性痴呆远期预后观察

目的观察麻痹性痴呆(GPI)经过青霉素治疗后的中远期预后,评估青霉素治疗GPI方案的优缺点。方法采用5周疗程的大剂量青霉素治疗GPI的方案,对72例GPI患者进行治疗并随访半年以上。评价疗效,观察半年内临床症状变化,及6个月后分别评价智能、梅毒血清抗体滴度。结果有65例完成随访,80%(52/65)患者在完成5周的治疗时智能好转,但46.15%(30/65)在半年随访期间临床症状加重。在完成5周的治疗后简易智力状态检查量表(MMSE)评分上升(P<0.001);随访半年后,MMSE评分又下降(P<0.001)。经过治疗后血浆TRUST滴度有下降(P<0.001),半年后,TRUST滴度未再继续下降(P>0.10)。结论目前国内普遍采用的青霉素治疗GPI的方案近期疗效好,但部分患者体内的梅素螺旋体未完全灭活,半年内病情加重的机率高,需要继续随诊,并定期复查,有必要探索更加合理的治疗方案。

Prognosis of patients with GPI treated with penicillin G

Objective To evaluate the advantage and disadvantage of long term penicillin G injection in treatment of general paralysis of the insane(GPI).Methods 72 cases of patients with GPI were treated with high dose of penicillin G and were followed up for more than half a year.Therapeutic effect and aggravation in half a year was observed.MMSE and serum TRUST and TRHA was examined at the just time of pretherapy,post-treatment,and after half a year.Results 65 cases completed the follow-up.80%(52/65) of the patients improved by the time of post-treatment but 46.15%(30/65) increased in 6 months.Scores of MMSE went up(P<0.001) but went down(P<0.001) in the next 6 months.tite of plasma TRUST descended(P<0.001) after the treatment and maintain in the next 6 months.Conclusion Therapeutic effect of penicillin G is nice in the near future.However treponema in patients body is not inactived completely,and much patients's pathognetic condition aggravated in an half year,and needed to be re-checked in time.More reasonable therapeutic regimen should be explored.