發(fā)布時間：2018-04-25 01:10

  本文選題：神經梅毒 + 臨床表現(xiàn)�。� 參考：《寧夏醫(yī)科大學》2017年碩士論文

【摘要】：目的總結并分析寧夏地區(qū)神經梅毒患者的流行病學資料、臨床表現(xiàn)、實驗室檢查及影像學表現(xiàn),提高臨床醫(yī)師對該病的認識,爭取早期診斷、早期治療,減少漏診、誤診。方法對2003年至2016年期間就診于寧夏醫(yī)科大學總醫(yī)院及心腦血管病醫(yī)院診斷為神經梅毒的22例患者病歷資料進行回顧性分析,并根據2014年中國梅毒診療指南提出的神經梅毒診斷標準對病例資料進行再判斷。結果1、本組資料中男性患者19例,女性患者3例,以中年組41-65歲居多,2009年后發(fā)病例數(shù)明顯增加;2、1例患者承認冶游史,1例合并HIV感染,1例兩者均有;3、臨床分型中以麻痹性癡呆最多見(31.8%),其余依次為腦膜、脊髓膜血管梅毒(27.3%)、腦膜神經梅毒(22.7%)、脊髓癆(9.1%)、先天性神經梅毒(9.1%);4、22例患者均完善了血清梅毒聯(lián)檢,梅毒螺旋體特異性抗體檢測(TPPA或TP-CLI)及梅毒螺旋體非特異性抗體檢測(RPR或TRUST)均為陽性;5、腦脊液檢查中顱內壓5例180mm H20,占23.8%(5/21),22例患者CSF白細胞計數(shù)均≥5個/mm3,在5-330個/mm3之間,均數(shù)為37個/mm3,細胞學分類大多以淋巴細胞為主,CSF生化檢查中蛋白含量均0.5g/L,在0.74-11.96g/L之間,均數(shù)為1.207g/L,葡萄糖或氯化物含量正常或稍降低;6、22例患者中2例未行腦脊液梅毒檢查,1例腦脊液TPPA及TRUST檢查均為陰性,其余19例患者中梅毒螺旋體特異性抗體檢測(TPPA或TP-CLI)均為陽性,梅毒螺旋體非特異性抗體檢測(RPR或TRUST)中5例TRUST檢測為陰性,14例陽性;7、頭顱影像學檢查無明顯特異性,可表現(xiàn)為急性腦梗死、腦室擴大、腦萎縮、腦膜強化、脫髓鞘改變等;8、患者在接受青霉素或頭孢曲松治療后,癥狀較前明顯改善。結論1、神經梅毒發(fā)病率逐年增高,起病隱匿且臨床表現(xiàn)不典型,初診診斷率低,易被誤診。2、臨床工作中應對顱內感染、認知功能減退、精神類疾病及不明原因癲癇發(fā)作、腦梗死(特別是成年人首發(fā)癲癇及青年腦梗死)等患者警惕神經梅毒的可能,必要時完善梅毒相關檢查以減少漏診、誤診。3、早期、足劑量、足療程的抗梅毒治療可以改善預后,應爭取早期診斷、早期治療。
[Abstract]:Objective to summarize and analyze the epidemiological data, clinical manifestations, laboratory and imaging findings of patients with neurosyphilis in Ningxia, to improve the understanding of the disease, to strive for early diagnosis, early treatment, reduce missed diagnosis and misdiagnosis. Methods the medical records of 22 patients with neurosyphilis diagnosed in the General Hospital of Ningxia Medical University and the Cardiovascular and Cerebrovascular Disease Hospital from 2003 to 2016 were retrospectively analyzed. According to the criteria of neurosyphilis diagnosis and treatment in China in 2014, the case data were rejudged. Results 1. There were 19 male and 3 female patients in this group. In the middle age group, 41-65 years old was the majority, and the number of cases increased significantly in 2009. One patient admitted to the history of HIV infection and one patient with HIV infection and one patient had 3 cases of HIV infection. In the clinical classification, palsy dementia was the most common type, and the rest was meningeal. Meningeal nerve syphilis, meningeal nerve syphilis, meningeal nerve syphilis, tuberculous phlegm, and congenital neurosyphilis, 422 patients with congenital neurosyphilis have improved the level of serum syphilis. TPPA or TP-CLI) of Treponema pallidum and non-specific antibody of Treponema pallidum were all positive. Intracranial pressure (180mm H20) was found in 5 cases of cerebrospinal fluid examination, accounting for 23.875% of 22 patients with TP-CLI. The white blood cell count of CSF in 22 patients was more than 5% mmm3, ranging from 5 to 330 / mm3. The mean value was 37 / mm ~ (-3), and most of the cytological classification was mainly lymphocytic. The protein content in the biochemical examination was 0.5g / L, between 0.74-11.96g/L, The mean value was 1.207g / L, 2 out of 22 patients with normal or slightly decreased glucose or chloride content were not tested for cerebrospinal fluid syphilis and 1 was negative for cerebrospinal fluid (CSF) TPPA and TRUST, and the other 19 patients were positive for Treponema pallidum specific antibody detection. In 5 cases of TRUST, 14 cases were positive for TRUST and 14 cases were positive for trust. There was no obvious specificity in cranial imaging examination, which could be characterized by acute cerebral infarction, ventricular enlargement, cerebral atrophy, meningeal enhancement, and no significant difference was found in the detection of Treponema pallidum (Treponema pallidum). After treatment with penicillin or ceftriaxone, the symptoms were significantly improved. Conclusion 1. The incidence of neurosyphilis is increasing year by year, the onset of neurosyphilis is hidden and the clinical manifestation is not typical, the rate of initial diagnosis is low, and it is easy to be misdiagnosed. Patients with cerebral infarction (especially adults with first-episode epilepsy and young cerebral infarction) are alert to the possibility of neurosyphilis, and improve syphilis related examination if necessary to reduce missed diagnosis, misdiagnosis, early, sufficient dosage, and sufficient course of antisyphilis treatment can improve the prognosis. We should strive for early diagnosis and treatment.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R759.13

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