HIV阴性神经梅毒18例临床分析

目的探讨神经梅毒的临床特点、实验室检查、治疗与预后的关系。方法18例神经梅毒的临床资料进行回顾性分析。结果18例神经梅毒患者中男16例，女2例；平均发病年龄50．6岁，其中麻痹性痴呆9例，其次为脊髓痨3例，无症状型2例，视神经炎2例，脑膜型1例，脑膜血管型1例。血清快速血浆反应素环状卡片试验、梅毒螺旋体颗粒凝集试验均为阳性，脑脊液检查：lO例快速血浆反应素环状卡片试验阳性，18例梅毒螺旋体颗粒凝集试验均为阳性，10例蛋白定量〉500mg／L；12例白细胞数≥10×10^9／L，CT、磁共振成像、肌电图等均无特异性，首诊误诊率为77．8％。结论神经梅毒临床表现复杂多样，误诊率高，预后较差，应重视脑脊液检查。

Clinical analysis of 18 human immunodeficiency virus-negative patients with neurosyphilis

Objective To analyze the clinical and laboratory features as well as relationship between treatment and prognosis of neurosyphilis. Methods A retrospective study was perfoimed on 18 human immunodeficiency vires （HIV）-negative inpatients with neurosyphilis collected at the Department of Dermatology and Venereology, Fifth People＇s Hospital of Suzhou from 2009 to 2013. Results Of the 18 patients, 16 were male and 2 were female with the mean age at onset being 50.6 years. The most common clinical type was general paresis of insane （9 cases）, followed by tabes dorsalis （3 cases）, asymptomatic type （2 cases）, optic neuritis （2 cases）, meninges type （1 case）, and meningovascular type （1 case）. Both serum rapid plasma reagin （RPR） test and Treponema pallidum particle agglutination assay （TPPA） were positive in all the patients. Cerebrospinal fluid （CSF） analysis revealed that the RPR test was positive in 10 patients, TPPA positive in all the patients, the protein level higher than 500 mg/L in 10 patients, and the white blood cell count≥10×10^9/L in 12 patients. No abnormality was found on computed tomography （CT）, magnetic resonance imaging （MRI） or electromyogram. The misdiagnosis rate was 77.8% for neurosyphilis at the first visit. Conclusions Neurosyphilis has diverse clinical manifestations with a high misdiagnosis rate and poor prognosis, and attention should be paid to the examination of cerebrospinal fluid.