梅毒血清学试验阳性患者1O例临床分析

目的探讨合并神经系统病变梅毒患者的临床表现、诊断和治疗方法。方法分析10例梅毒血清学试验阳性的梅毒患者的临床特点、血清学及脑脊液检查、影像学表现、诊断、分型及治疗结果等。结果10例患者中据脑脊液结果确诊神经梅毒8例、疑诊1例、非神经梅毒1例。8例神经梅毒确诊病例中脊髓痨型3例、梅毒性脑膜炎2例、麻痹性痴呆1例，树胶肿性神经梅毒1例，脑血管梅毒1例。头颅及脊髓MRI检查异常无明显特异性。青霉素治疗10例，有效9例，失访1例。治疗后脑脊液蛋白、白细胞、压力、脑脊液非螺旋体抗原滴度有不同程度下降。10例患者均未发生赫氏反应。结论神经梅毒临床表现多样，脑脊液检查是诊断的关键。

Clinical Analysis of 10 Cases with Positive Serological Response to Syphilis

Objective To analyze the manifestation,diagnosis and therapy effects in the syphilit- ic patients with central nervous system abnormalities. Methods I0 cases of patients with syphilis were studied retrospectively,lncluding their clinical characteristics, abnormalities of serum, CSF, MRI, diagno- sis,type and response to therapy. Results According to the CSF findings [ including cell counts,total pro- tein, pressure, and titer of the TPPA and RPR test], of 10 cases,8 cases were proved neurosyphilis and 1 case was suspected;1 case was excluded neurosyphilis. Of 8 neurosyphilis patients,3 cases had tabes dor- salis ,2 cases had meninges syphilis, 1 case had general paresis of insane （GPI）, 1 case had cerebral gum- ma, 1 case had meningovascular syphilis. 10 cases received standard therapy（ penicillin）, the treatments were effective in 9 patients and 1 patient were lost of follow-up. The cell count,total protein and pressure of CSF, titer of RPR in serum and CSF were decreased after treatment and no Jarisch-Herxheimer reaction was found in 10 patients. Conclusion The clinical manifestation of neurosyphilis were complex and varied. The examination of the CSF were necessaIT for the diagonosis of neurosvohilis.