神经梅毒的临床特征分析

Clinical characteristics of neurosyphilis: a report of 5 cases

关键词:  神经梅毒  临床特征  脑膜血管梅毒  误诊

Key words:  neurosyphilis  clinical characteristics  meningovascular syphilis  misdiagnosis

摘要:

目的 分析神经梅毒的临床特征,提高其早期诊断准确性。方法 回顾性分析5例确诊的神经梅毒患者的临床表现、辅助检查、治疗及误诊情况。结果 神经梅毒的临床特征包括：中年人群发病,可急性、亚急性或慢性起病;临床以间质型为主,脑膜血管梅毒多见;梅毒快速血浆反应素试验及梅毒螺旋体颗粒凝集试验阳性;脑脊液中蛋白含量增高,性病研究实验室试验阳性,其中2例有白细胞增高;早期均有误诊。结论 神经梅毒临床表现复杂多样,与分型有关,误诊率高。神经系统损害的症状、体征结合梅毒血清学及脑脊液检查有助于确诊。

Abstract:

Objective To analyze the clinical characteristics of neurosyphilis.Methods Clinical manifestation,diagnostic investigation,misdiagnosis and treatment of 5 cases with neurosyphilis were analyzed retrospectively.Results All patients were mid-aged with acute,subacute or chronic onset.Interstitial neurosphilis,especially meningovascular syphilis was the common type. Serological rapid plasma reagin(RPR) test and treponema pallidum particle agglutination(TPPA) test showed positive reaction.The cerebrospinal fluid(CSF) abnormalities consisted of elevation of protein,positive results of Venereal Disease Research Laboratory(VDRL) test and 2 cases showed pleocytosis.All cases were misdiagnosed at early stage.Conclusion The clinical manifestation of neurosyphilis are complex and diverse,related to pathological type,misdiagnosis rate is high.Neurological symptoms and signs combines with syphilis- specific serological and CSF tests can help to make accurate diagnosis.