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目的探讨神经梅毒(neurosyphilis)的临床特征、诊断和治疗情况。方法回顾性分析2006年8月至2013年8月收治的41例神经梅毒患者的一般情况、临床特征、实验室检查及治疗预后等临床资料。结果 41例神经梅毒中,无症状型5例(12.19%),脑膜炎型9例(21.95%)、脑膜血管型18例(43.90%),麻痹性痴呆型6例(14.63%)、脊髓痨型3例(7.32%)。41例患者血清学检查、脑脊液(CSF)检查均为阳性,CSF常规检查:白细胞数升高31例(75.61%),白细胞数(27.91±4.26)个/μl;CSF生化检查:CSF蛋白升高23例(56.10%),蛋白量(0.89±0.22)g/L。16例患者行颅脑CT检查:5例显示基底节区低密度梗死灶,1例显示管腔多发狭窄,其余未提示明显特异性病变。27例行颅脑MRI检查:3例为脑膜炎型,7例为脑膜血管型,2例为麻痹性痴呆型,其余未见明显异常。6例患者行脊髓MRI检查:2例为脊髓痨型,4例为无症状型。41例患者治疗后,均进行了1年的随访。2例患者梅毒病原体相关血清检查滴度无明显下降,需要重复治疗;其余39患者实验室检查结果均转阴痊愈。结论神经梅毒起病隐袭,临床表现复杂多样,应引起高度重视。该病应早诊断、早治疗,及时行血清及CSF梅毒抗体等检查,积极改善患者预后。
Objective To investigate the clinical features, diagnosis and treatment of neurosyphilis. Methods The clinical data of 41 cases of neurosyphilis admitted from August 2006 to August 2013 were analyzed retrospectively. The clinical data, laboratory tests and treatment prognosis were retrospectively analyzed. Results Among 41 cases of neurosyphilis, 5 cases (12.19%) were asymptomatic, 9 cases (21.95%) were meningitis, 18 cases (43.90%) were meningeal vessels, 6 cases (14.63%) were paralytic dementia, Type in 3 cases (7.32%). Serum tests and cerebrospinal fluid (CSF) tests were positive in 41 patients. CSF routine examination showed that the number of white blood cells increased by 31 (75.61%) and the number of white blood cells increased by 27.91 ± 4.26 / 23 cases (56.10%), the amount of protein (0.89 ± 0.22) g / L. 16 patients underwent brain CT examination: 5 cases showed basal ganglia low density infarction, 1 case showed multiple luminal stenosis, the rest did not prompt significant specific lesions. 27 cases of brain MRI examination: 3 cases of meningitis, 7 cases of meningeal vascular type, 2 cases of paralytic dementia, the other no obvious abnormalities. Six patients underwent spinal cord MRI: two cases of spinal cord, type, four cases of asymptomatic. After treatment, 41 patients were followed up for 1 year. Two patients with syphilis pathogens serum titer no significant decline, requiring repeated treatment; the remaining 39 patients were negative laboratory results were healed. Conclusion Neurosyphilis insidious onset, complex and diverse clinical manifestations, should be highly valued. The disease should be diagnosed as soon as possible, early detection of serum and CSF syphilis and other tests, and actively improve the prognosis of patients.