【摘要】：目的通過(guò)分析神經(jīng)梅毒(NS)的臨床特點(diǎn),為其早期診斷提供依據(jù)。方法回顧性分析山西省2家醫(yī)院(2所均為省級(jí)三甲綜合醫(yī)院,其中1所為教學(xué)醫(yī)院,1所為非教學(xué)醫(yī)院)共18例NS,并結(jié)合文獻(xiàn)對(duì)NS首發(fā)癥狀、實(shí)驗(yàn)室檢查、治療及療效進(jìn)行分析。結(jié)果 18例NS除了5種主要類(lèi)型的NS,即無(wú)癥狀型NS、腦脊膜梅毒、腦膜血管梅毒、腦實(shí)質(zhì)梅毒(麻痹性癡呆和脊髓結(jié)核)和樹(shù)膠樣腫性NS以外,還可以腦出血、癲癇、精神癥狀、言語(yǔ)行為異常等非典型癥狀首發(fā);非教學(xué)醫(yī)院9例,其中1例未做腰穿,3例未查腦脊液(CSF)性病系列,并不符合診斷標(biāo)準(zhǔn);教學(xué)醫(yī)院9例,均檢查了CSF系列;2周療程結(jié)束后患者癥狀均有不同程度好轉(zhuǎn),其中3例復(fù)查CSF,2例白細(xì)胞數(shù)及蛋白數(shù)降至正常,1例無(wú)變化,3例RPR滴度均下降1個(gè)滴度。余患者未復(fù)查CSF。結(jié)論 NS臨床表現(xiàn)多樣,特異性癥狀少,在臨床工作中極易被漏診及誤診,血清及CSF梅毒篩選及確診試驗(yàn)是診斷梅毒的關(guān)鍵環(huán)節(jié),2所醫(yī)院雖均為省級(jí)三甲醫(yī)院,但教學(xué)醫(yī)院比非教學(xué)醫(yī)院在診斷NS時(shí)更具規(guī)范性。因此提高對(duì)NS的認(rèn)識(shí)及規(guī)范化的實(shí)驗(yàn)室檢查及診療是早期診斷NS并降低并發(fā)癥的關(guān)鍵措施。青霉素仍是驅(qū)梅治療的首選藥物。
[Abstract]:Objective to analyze the clinical features of neurosyphilis (NS) and to provide evidence for its early diagnosis. Methods A retrospective analysis of 18 cases of NSs in 2 hospitals (2 provincial hospitals, 1 teaching hospital and 1 non-teaching hospital) in Shanxi Province was performed. The first symptom, laboratory examination, treatment and curative effect of NS were analyzed in combination with literature. Results in addition to 5 main types of NSs, including asymptomatic NSs, meningeal syphilis, meningeal vascular syphilis, cerebral parenchyma syphilis (paralytic dementia and spinal cord tuberculosis) and gum like swelling NS, 18 cases of NS could also have cerebral hemorrhage, epilepsy, and mental symptoms. There were 9 cases in non-teaching hospital, 1 case without lumbar puncture, 3 cases without cerebrospinal fluid (CSF) venereal disease series, 9 cases in teaching hospital, 9 cases in non-teaching hospital. The symptoms of all patients were improved in varying degrees after the end of 2 weeks of CSF treatment. In 3 cases, the leukocyte count and protein count of 2 cases with CSFU decreased to normal in 1 case, and the RPR titer of 3 cases decreased by 1 titer. CSF was not reexamined in other patients. Conclusion NS has various clinical manifestations and few specific symptoms. It is easy to be missed and misdiagnosed in clinical work. The screening and diagnosis of syphilis in serum and CSF are the key links in the diagnosis of syphilis. But the teaching hospital is more normative than the non-teaching hospital in the diagnosis of NS. Therefore, to improve the understanding of NS and standardized laboratory examination and diagnosis and treatment is the key to early diagnosis of NS and reduce complications. Penicillin is still the first choice in the treatment of plum.
【作者單位】： 山西醫(yī)科大學(xué)第二醫(yī)院皮膚性病科;山西省人民醫(yī)院神經(jīng)內(nèi)科;
【基金】：山西省軟科學(xué)研究項(xiàng)目(2011041073-02)
【分類(lèi)號(hào)】：R759.13

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