神经梅毒患者脑脊液改变与预后的关系

目的 探讨神经梅毒患者的脑脊液改变与预后的关系.方法 回顾性分析55例梅毒患者脑脊液及临床资料,其中,神经梅毒组30例,潜伏梅毒组25例,两组分别测定脑脊液压力、白细胞数、蛋白含量,同时测定血清及脑脊液中反应素环状卡片试验(RPR)、螺旋体明胶凝结试验(TPPA),并进行比较;所有患者均正规全程青霉素驱梅治疗;对两组患者门诊复诊或进行电话跟踪随访2年,并进行预后评定,同时进行功能独立性评定(FIM)评分.结果 两组患者血清PRP及TPPA均为阳性;神经梅毒组脑脊液白细胞数、蛋白含量较潜伏梅毒组高,差异有统计学意义(均P<0.01).治疗后,神经梅毒组无变化5例(16.7%),改善21例(70.0%),进展4例(13.3%);潜伏梅毒组无变化15例(60.0%),改善8例(32.0%),进展2例(8.0%).神经梅毒患者脑脊液白细胞数、蛋白含量以及RPR、TPPA滴度升高,与FIM评分呈负相关(分别r=-0.480、-0.504、-0.465及-0.550,均P<0.05).结论 神经梅毒患者脑脊液白细胞数、蛋白含量以及RPR、TPPA升高程度,均与预后密切相关,脑脊液改变越重,则预后越差.

Relationship beween cerebrospinal fluid changes and prognosis in patents with neurosyphilis

Objective To investigate the relationship between cerebrospinal fluid (CSF) changes and prognosis in patients with neurosyphilis.Methods The CSF and the clinical data of 55 syphilis patients were analysed retrospectively,including 30 neurosyphilis cases and 25 syphilis cases during incubation period.The CSF leukocyte, protein and pressure of the two groups were measured,meanwhile, rapid plasma regain circle card(RPR) and treponema pallidum particle assay (TPPA) were simultaneous determination. All cases were treated with penicillin G normally during the whole range.Two groups of patients were followed-up by telephones or outpatient department in two year and the prognosis were evaluated. Function Independent Measure (FIM) were scored at the same time.Results The seum RPR and TPPR in two group patients were all positivity CSF leukocyte and protein were higher in neurosyphilis than that of in syphilis incubation period, There was significant difference between the two groups (all P<0.01). After twieamer in neurosyphilis group, no change was 5 case(16.7%),improvement was 21 case(70.0%), progression was 4 case (13.3%). In syphilis incubation period group,no change was 15 case(60.0%),improvement was 8 case(32.0%),progression was 2 case(8.0%). The prognosis was worse in neurosyphilis than that of in syphilis incubation period after treatment. There was obvious negative correlation between CSF leukocyte, protein increasing, CSF RPR or TPPA titer increase and FIM scores (parate r=-0.480,-0.504,-0.465 and -0.550,all P<0.05). Conclusions There is a close relationship between CSF leukocyte, protein increasing, CSF RPR or TPPA liter increase and prognosis.The severer the CSF change, the poorer the prognosis.