21例神经梅毒临床特征及实验室结果分析

目的 分析神经梅毒患者临床特征及实验室检查指标,为神经梅毒的早期诊断、治疗提供参考依据。方法 回顾分析2020年9月至2021年12月安徽医科大学第一附属医院收治的21例神经梅毒住院患者临床资料,统计分析该疾病的临床特征、实验室检查、颅脑MRI检查结果。结果 21例神经梅毒(11例早期,10例晚期)患者中,男女性别比为1.33:1;年龄23~67岁,发病年龄30~57岁,共17例(80.95%);11例早期神经梅毒患者中,9例(81.82%)无明显临床表现;10例晚期神经梅毒患者均表现为麻痹性痴呆。21例患者中,10例(47.62%)患者脑脊液快速血浆反应素试验(RPR)阳性,13例(61.9%)患者脑脊液白细胞计数升高,17例(80.95%)患者脑脊液蛋白升高;13例(61.9%)患者颅脑MRI可见异常改变;青霉素规范驱梅治疗有效率为80.95%,4例治疗效果不佳者均为晚期患者。结论 神经梅毒发病男性略多于女性,发病主要为青壮年。早期神经梅毒无明显临床症状;晚期神经梅毒可出现精神、行为异常,此病诊断必须综合临床特征、实验室检查及MRI检查,规范化青霉素治疗对早期患者有较好疗效。

Analysis of clinical features and laboratory results of 21 cases of neurosyphilis

Objective To analyze the clinical features and laboratory examination indicators of neurosyphilis patients in an effort to provide a point of reference for early diagnosis and early treatment of neurosyphilis. Methods Retrospective analysis was conducted among 21 neurosyphilis patients admitted into the First Affiliated Hospital of Anhui Medical University during September2020 and December 2021. Meanwhile,the clinical features, laboratory examination and craniocerebral MRI examination of the diseasewere statisticallyanalyzed.Results A total of 21 cases of neurosyphilis comprised 11 of early neurosyphilis and 10 of advanced neurosyphilis, with a sex ratio of 1.33 to 1, an age group of 23-67, aged 30~57 (17 cases, 80.95%); of the 11 patients with early neurosyphilis, 9 patients (81.82%) had no obvious clinical symptoms; 10 patients with advanced neurosyphilis showed paralytic dementia unexceptionally. Of the 21 patients, 10 (47.62%) had positive CSF RPR test results, 13 (61.9%) had elevated CSF white blood cell count, 17 (80.95%) had rising CSF protein; 13 (61.9%) experienced visible abnormalities indicated by craniocerebral MRI. With standardized penicillin treatment, 80.95% of the patients had effective improvements, while 4 patients of advanced neurosyphilis had unsatisfactory results. Conclusions Neurosyphilis occurs more in male patients than in female patients, particularly in young adults. Early neurosyphilis has no obvious clinical symptoms; advanced neurosyphilis may come with mental and behavioral disorders, and the diagnosis must be made in combination with clinical features, laboratory examination and MRI examination; standardized penicillin treatment has better efficacy for early neurosyphilis patients.