54例神經(jīng)梅毒臨床特征分析
發(fā)布時(shí)間：2018-07-15 10:57
【摘要】：目的:神經(jīng)梅毒(neurosyphilis,NS)系由蒼白密梅毒螺旋體(treponema pallidum,TP)侵入人體神經(jīng)系統(tǒng)以后,出現(xiàn)的腦脊膜、血管或腦脊髓實(shí)質(zhì)損害的一組臨床綜合征,是晚期(III期)梅毒全身性損害的重要表現(xiàn)。近年來梅毒在全世界范圍內(nèi)增長迅速,合并HIV感染的患病人群大量增加。梅毒的臨床表現(xiàn)復(fù)雜多樣,被稱為“最杰出的模仿者”,目前尚無診斷金標(biāo)準(zhǔn),早期規(guī)范抗生素治療有效,而未經(jīng)治療者晚期階段致殘率和致死率高。本文總結(jié)54例神經(jīng)梅毒患者的臨床特征及診治要點(diǎn),以期提高該病的早期診斷和治療水平。材料與方法:本研究參照美國疾病控制中心2010年神經(jīng)梅毒診斷標(biāo)準(zhǔn),收集大連醫(yī)科大學(xué)附屬第一醫(yī)院及大連市皮膚病醫(yī)院自2010年6月至2015年7月診治的神經(jīng)梅毒患者共54例,回顧性分析一般資料、病史資料、神經(jīng)系統(tǒng)體格檢查、實(shí)驗(yàn)室檢查、影像學(xué)檢查、診療經(jīng)過及預(yù)后,進(jìn)行臨床分型,總結(jié)了神經(jīng)梅毒的臨床特征、影像學(xué)特點(diǎn)及診治要點(diǎn)。結(jié)果:(1)54例神經(jīng)梅毒患者,男34例,女20例,年齡為24歲至77歲(平均48.1±14.4歲),9例存在梅毒感染史,10例患者承認(rèn)存在冶游史,2例患者合并HIV感染,3例已婚患者配偶存在梅毒感染史。明確冶游史患者中,發(fā)病最短者為接觸史半年,最長者為接觸史44年�；颊呗殬I(yè)分布中無業(yè)人員所占比例最大(72.1%),婚姻狀況以已婚人員所占比例最大(85.2%)。(2)臨床分型:無癥狀型神經(jīng)梅毒37例(68.5%),無明確神經(jīng)系統(tǒng)癥狀及定位體征,3例存在阿-羅瞳孔;腦膜神經(jīng)梅毒4例(7.4%),主要表現(xiàn)為發(fā)熱、頭痛、頸項(xiàng)強(qiáng)直,視物模糊,耳鳴、耳聾,結(jié)膜充血;腦膜、脊髓膜血管梅毒2例(3.7%),主要表現(xiàn)為頭暈、頭痛,偏癱、肢體麻木無力,不完全運(yùn)動型失語;脊髓癆2例(3.7%),主要表現(xiàn)為發(fā)熱,肢體麻木無力,尿便障礙;麻痹性神經(jīng)梅毒9例(16.7%),主要表現(xiàn)為認(rèn)知障礙,精神行為異常,言語障礙,動作笨拙、肢體震顫,癇性發(fā)作,阿-羅瞳孔,卒中樣表現(xiàn)。(3)54例患者血清梅毒螺旋體明膠凝集試驗(yàn)(treponema pallidum agglutination assay,TPHA)均陽性,快速血漿反應(yīng)素試驗(yàn)(rapid plasma reagin,RPR)介于1:4~1:64。51例患者行腰椎穿刺術(shù)采集腦脊液(Cerebrospinal fluid,CSF)行TPHA,均為陽性,RPR介于1:1~1:16,其中6例麻痹性神經(jīng)梅毒患者的CSF白細(xì)胞數(shù)和蛋白含量增高,異常比例100%。(4)影像學(xué)檢查發(fā)現(xiàn)3例腦膜神經(jīng)梅毒患者頭MRI表現(xiàn)為小片狀或點(diǎn)狀長T1長T2信號,位于單側(cè)或雙側(cè)顳葉,額葉強(qiáng)化病灶;1例腦膜脊髓膜血管梅毒頭MRI表現(xiàn)為輕度腦白質(zhì)脫髓鞘改變,基底節(jié)區(qū)低密度灶;1例脊髓癆患者頸椎MRI表現(xiàn)為C5水平髓內(nèi)片狀長T1長T2信號灶,1例未見明顯異常;9例麻痹性神經(jīng)梅毒患者頭MRI主要表現(xiàn)為嚴(yán)重脫髓鞘改變,額葉顳葉多發(fā)缺血灶及不同程度腦萎縮,伴有腦室系統(tǒng)擴(kuò)大、腦積水。(5)51例患者行規(guī)范化驅(qū)梅治療,“治愈”患者人數(shù)41例(占80.4%),無效4例(7.8%),失訪6例(11.8%);重啟治療患者5例(9.8%),其中3例(5.8%)再次治療有效,治療失敗2例(3.9%);合并HIV感染的2例(3.9%)治療不佳。結(jié)論:1.神經(jīng)梅毒患者男性多于女性,平均發(fā)病年齡48.1±14.4歲,具有冶游史、梅毒感染史、HIV感染和配偶存在梅毒感染是神經(jīng)梅毒發(fā)生的高危人群。2.TP可在接觸感染后半年至44年侵及神經(jīng)系統(tǒng),故臨床應(yīng)注意對梅毒患者盡早行神經(jīng)梅毒篩查。3.臨床中神經(jīng)梅毒分為無癥狀型神經(jīng)梅毒、腦膜神經(jīng)梅毒、腦膜脊髓膜血管梅毒、脊髓癆及麻痹性神經(jīng)梅毒五種類型,其中無癥狀型神經(jīng)梅毒患者人數(shù)最多(37例,占68.5%),麻痹性神經(jīng)梅毒次之(9例,占16.7%)。4.常規(guī)行血清TPHA檢測可發(fā)現(xiàn)梅毒患者,對有神經(jīng)系統(tǒng)癥狀或無癥狀但監(jiān)測血清RPR持續(xù)不降的梅毒患者需腰穿行CSF TPHA和RPR檢測,有助于確診神經(jīng)梅毒;麻痹性神經(jīng)梅毒患者CSF白細(xì)胞數(shù)和蛋白含量均升高,可以協(xié)助診斷麻痹性神經(jīng)梅毒。5.神經(jīng)梅毒患者磁共振表現(xiàn)復(fù)雜、無特異性。6.早期規(guī)范化驅(qū)梅治療治療可較好的改善神經(jīng)梅毒的臨床預(yù)后。
[Abstract]:Objective: neurosyphilis (NS) is a group of clinical syndromes of the brain spinal meninges, blood vessels, or brain and spinal parenchyma after the intrusion of Treponema pallidum (TP) to the human nervous system. It is an important manifestation of systemic damage in the late (III phase) syphilis. The prevalence of HIV infection has increased in large numbers. The clinical manifestations of syphilis are complex and diverse, which are called "the most outstanding imitators". There is no diagnostic gold standard, early standard antibiotic treatment is effective, and the untreated patients have high mortality and disability in the late stage. The clinical features and diagnosis and treatment points of 54 patients with neurosyphilis are summarized in this paper. In order to improve the early diagnosis and treatment level of the disease. Materials and methods: in this study, 54 cases of neuromei patients were collected from June 2010 to July 2015 from the First Affiliated Hospital of Dalian Medical University and Dalian City Dermatology Hospital with reference to the diagnostic standard of neurosyphilis in 2010, and the general data were analyzed retrospectively. Medical history, nervous system physical examination, laboratory examination, imaging examination, diagnosis and treatment and prognosis, clinical classification, summarized the clinical features of neurosyphilis, imaging features and diagnosis and treatment points. Results: (1) 54 cases of neurosyphilis, 34 men, 20 cases, age from 24 to 77 years (mean 48.1 + 14.4 years), 9 cases of syphilis infection History, 10 patients admitted the existence of history of travel, 2 patients with HIV infection, 3 married couples had a history of syphilis infection. The shortest incidence was the history of contact history for half a year, the longest was 44 years of contact history. The proportion of unemployed persons in the occupational distribution was the largest (72.1%), and the proportion of married people was the largest (8 5.2%) (2) clinical classification: 37 cases of asymptomatic neurosyphilis (68.5%), no definite nervous system symptoms and positioning signs, 3 cases of opioid pupil, 4 cases of meningeal neurosyphilis (7.4%), mainly characterized by fever, headache, neck rigidity, blurred visual substance, tinnitus, hearing loss, conjunctival congestion, and 2 cases (3.7%) of meninges and spinal meningeal syphilis (3.7%), mainly manifested dizziness, Headache, hemiplegia, numbness and weakness of limbs, incomplete motor aphasia, 2 cases of tuberculosis (3.7%), mainly manifested as fever, numbness and weakness of the limbs, urinary disorders, 9 cases of paralytic neurosyphilis (16.7%), mainly manifested as cognitive impairment, abnormal mental behavior, speech disorder, clumsy movement, limb tremor, epileptic seizures, opioid pupil, apoplexy appearance. (3) 54 Patients with serum Treponema pallidum gelatin agglutination test (Treponema pallidum agglutination assay, TPHA) were both positive, and the rapid plasma reacin test (rapid plasma reagin, RPR) was in 1:4~1:64.51 patients with lumbar puncture and collected cerebrospinal fluid (Cerebrospinal fluid), both were positive, and 6 cases were paralyzed. The number and protein content of CSF in patients with neurosyphilis increased, and the abnormal proportion of 100%. (4) imaging findings found that the head MRI of 3 cases of meningeal neurosyphilis showed small slice or long T1 long T2 signal, located in unilateral or bilateral temporal lobe and frontal lobe, and 1 cases of meningospinal vascular syphilis MRI showed mild white matter demyelination. The MRI manifestations of cervical vertebrae in 1 cases were C5 level and long T1 long T2 signal of intramedullary slice and long T1 long T2 signal. The head MRI of the 9 cases of paralytic neurosyphilis was mainly characterized by severe demyelination, multiple focal cerebral ischemia in the frontal and temporal lobe and different degrees of brain atrophy, with ventricle system enlargement and hydrocephalus (5) 51 cases. There were 41 cases of "cured" patients (80.4%), 4 cases (7.8%), 6 cases (11.8%), 5 cases (9.8%) restarted, 3 cases (5.8%), 2 (3.9%), and 2 cases (3.9%) with HIV infection. Conclusion: more men than women, average age of onset of neurosyphilis. 8.1 + 14.4 years old, with history of swimming, history of syphilis infection, HIV infection and syphilis infection in spouses is a high risk group for neurosyphilis,.2.TP can invade the nervous system for six months to 44 years after contact infection. Therefore, the clinical attention should be paid to the early neurosyphilis screening for syphilis patients in.3. clinical neurosyphilis divided into asymptomatic neurosyphilis, meninges Five types of neurosyphilis, meningospinal vascular syphilis, tuberculosis and paralytic neurosyphilis, among which, the number of asymptomatic neurosyphilis (37 cases, 68.5%), paralytic neurosyphilis (9 cases, 16.7%).4. routine serum TPHA detection can be found in the patients with the symptoms of nervous system or asymptomatic but monitoring serum RPR Patients with persistent syphilis should be tested with CSF TPHA and RPR for diagnosis of neurosyphilis. The number and protein content of CSF in patients with paralytic neurosyphilis are increased, which can help diagnose the complex magnetic resonance of the patients with.5. neurosyphilis of paralytic neurosyphilis, and the treatment of early standardized.6. for the treatment of the paralytic neurosyphilis is better. To improve the clinical prognosis of neurosyphilis.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R759.13
本文編號：2123839
[Abstract]:Objective: neurosyphilis (NS) is a group of clinical syndromes of the brain spinal meninges, blood vessels, or brain and spinal parenchyma after the intrusion of Treponema pallidum (TP) to the human nervous system. It is an important manifestation of systemic damage in the late (III phase) syphilis. The prevalence of HIV infection has increased in large numbers. The clinical manifestations of syphilis are complex and diverse, which are called "the most outstanding imitators". There is no diagnostic gold standard, early standard antibiotic treatment is effective, and the untreated patients have high mortality and disability in the late stage. The clinical features and diagnosis and treatment points of 54 patients with neurosyphilis are summarized in this paper. In order to improve the early diagnosis and treatment level of the disease. Materials and methods: in this study, 54 cases of neuromei patients were collected from June 2010 to July 2015 from the First Affiliated Hospital of Dalian Medical University and Dalian City Dermatology Hospital with reference to the diagnostic standard of neurosyphilis in 2010, and the general data were analyzed retrospectively. Medical history, nervous system physical examination, laboratory examination, imaging examination, diagnosis and treatment and prognosis, clinical classification, summarized the clinical features of neurosyphilis, imaging features and diagnosis and treatment points. Results: (1) 54 cases of neurosyphilis, 34 men, 20 cases, age from 24 to 77 years (mean 48.1 + 14.4 years), 9 cases of syphilis infection History, 10 patients admitted the existence of history of travel, 2 patients with HIV infection, 3 married couples had a history of syphilis infection. The shortest incidence was the history of contact history for half a year, the longest was 44 years of contact history. The proportion of unemployed persons in the occupational distribution was the largest (72.1%), and the proportion of married people was the largest (8 5.2%) (2) clinical classification: 37 cases of asymptomatic neurosyphilis (68.5%), no definite nervous system symptoms and positioning signs, 3 cases of opioid pupil, 4 cases of meningeal neurosyphilis (7.4%), mainly characterized by fever, headache, neck rigidity, blurred visual substance, tinnitus, hearing loss, conjunctival congestion, and 2 cases (3.7%) of meninges and spinal meningeal syphilis (3.7%), mainly manifested dizziness, Headache, hemiplegia, numbness and weakness of limbs, incomplete motor aphasia, 2 cases of tuberculosis (3.7%), mainly manifested as fever, numbness and weakness of the limbs, urinary disorders, 9 cases of paralytic neurosyphilis (16.7%), mainly manifested as cognitive impairment, abnormal mental behavior, speech disorder, clumsy movement, limb tremor, epileptic seizures, opioid pupil, apoplexy appearance. (3) 54 Patients with serum Treponema pallidum gelatin agglutination test (Treponema pallidum agglutination assay, TPHA) were both positive, and the rapid plasma reacin test (rapid plasma reagin, RPR) was in 1:4~1:64.51 patients with lumbar puncture and collected cerebrospinal fluid (Cerebrospinal fluid), both were positive, and 6 cases were paralyzed. The number and protein content of CSF in patients with neurosyphilis increased, and the abnormal proportion of 100%. (4) imaging findings found that the head MRI of 3 cases of meningeal neurosyphilis showed small slice or long T1 long T2 signal, located in unilateral or bilateral temporal lobe and frontal lobe, and 1 cases of meningospinal vascular syphilis MRI showed mild white matter demyelination. The MRI manifestations of cervical vertebrae in 1 cases were C5 level and long T1 long T2 signal of intramedullary slice and long T1 long T2 signal. The head MRI of the 9 cases of paralytic neurosyphilis was mainly characterized by severe demyelination, multiple focal cerebral ischemia in the frontal and temporal lobe and different degrees of brain atrophy, with ventricle system enlargement and hydrocephalus (5) 51 cases. There were 41 cases of "cured" patients (80.4%), 4 cases (7.8%), 6 cases (11.8%), 5 cases (9.8%) restarted, 3 cases (5.8%), 2 (3.9%), and 2 cases (3.9%) with HIV infection. Conclusion: more men than women, average age of onset of neurosyphilis. 8.1 + 14.4 years old, with history of swimming, history of syphilis infection, HIV infection and syphilis infection in spouses is a high risk group for neurosyphilis,.2.TP can invade the nervous system for six months to 44 years after contact infection. Therefore, the clinical attention should be paid to the early neurosyphilis screening for syphilis patients in.3. clinical neurosyphilis divided into asymptomatic neurosyphilis, meninges Five types of neurosyphilis, meningospinal vascular syphilis, tuberculosis and paralytic neurosyphilis, among which, the number of asymptomatic neurosyphilis (37 cases, 68.5%), paralytic neurosyphilis (9 cases, 16.7%).4. routine serum TPHA detection can be found in the patients with the symptoms of nervous system or asymptomatic but monitoring serum RPR Patients with persistent syphilis should be tested with CSF TPHA and RPR for diagnosis of neurosyphilis. The number and protein content of CSF in patients with paralytic neurosyphilis are increased, which can help diagnose the complex magnetic resonance of the patients with.5. neurosyphilis of paralytic neurosyphilis, and the treatment of early standardized.6. for the treatment of the paralytic neurosyphilis is better. To improve the clinical prognosis of neurosyphilis.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R759.13
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