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目的探讨不同类型神经梅毒的流行病学及临床特征。方法回顾性分析2009-2013年在北京地坛医院收治的117例不同类型神经梅毒患者的流行病学特征、临床症状与体征、实验室及影像学检查、治疗及转归。结果共收集117例成人神经梅毒病例,其中无症状型神经梅毒47例(40.2%),间质型神经梅毒19例(16.2%),实质型神经梅毒51例(43.6%)。实质型患者的平均年龄(50.12±10.35岁)明显高于无症状型患者(43.66±14.12岁)(t=2.564,P=0.012),且实质型患者男性比例明显高于其他两组。实质型患者脑脊液蛋白平均浓度为(67.14±30.57mg/dL),明显高于无症状型患者的(44.97±37.99mg/dL)(t=3.117,P=0.002);实质型患者的脑脊液快速血浆反应素环状卡片试验(RPR)阳性率为91.8%(45/49)(2例未在本院检查),明显高于无症状型的53.2%(25/47)和间质型的68.4%(13/19),差异有统计学意义(χ2=18.142,P=0.000;χ2=5.985,P=0.023)。无症状型中颅脑MRI或CT检查呈阴性者占80.0%,间质型中表现为脑缺血、脑梗死样改变者占50.0%,阴性者占41.7%,而实质型中表现为脑萎缩者占56.8%、脑缺血及梗死样改变占37.8%;间质型和实质型神经梅毒的误诊率达41.4%,其中以误诊为精神障碍者为主。结论实质型神经梅毒仍以中老年男性为主,精神行为异常、认知障碍等为最常见的临床表现,影像学检查异常率较高。对神经梅毒的高危人群行血清学筛查,有利于疾病的早期诊断早期治疗,神经梅毒的分型管理对疾病的个体化治疗可能有积极意义。
Objective To investigate the epidemiology and clinical features of different types of neurosyphilis. Methods The epidemiological characteristics, clinical signs and symptoms, laboratory and imaging examination, treatment and prognosis of 117 patients with different types of neurosyphilis admitted from 2009 to 2013 in Beijing Ditan Hospital were retrospectively analyzed. Results A total of 117 cases of adult neurosyphilis were collected, including asymptomatic neurosyphilis in 47 cases (40.2%), interstitial neurosyphilis in 19 cases (16.2%) and parenchymal neurosyphilis in 51 cases (43.6%). The average age of patients in real type (50.12 ± 10.35 years) was significantly higher than that of asymptomatic patients (43.66 ± 14.12 years) (t = 2.564, P = 0.012). The percentage of male patients in real patients was significantly higher than that in other two groups. The average concentration of cerebrospinal fluid protein in patients with parenchyma was 67.14 ± 30.57mg / dL, which was significantly higher than that of asymptomatic patients (44.97 ± 37.99mg / dL) (t = 3.117, P = 0.002) The positive rate of RPR was 91.8% (45/49) (2 not tested in our hospital), which was significantly higher than that of asymptomatic 53.2% (25/47) and interstitial 68.4% (13/19), the difference was statistically significant (χ2 = 18.142, P = 0.000; χ2 = 5.985, P = 0.023). Asymptomatic medium cranial MRI or CT examination was negative for 80.0%, interstitial type showed cerebral ischemia, cerebral infarction-like changes accounted for 50.0%, negative accounted for 41.7%, while in the real performance of brain atrophy Accounting for 56.8%, cerebral ischemia and infarction-like changes accounted for 37.8%; interstitial and parenchymal neurosyphilis misdiagnosis rate of 41.4%, of which misdiagnosed as mental disorders. Conclusion The main type of neurosyphilis is still the most common form of middle-aged and elderly men with abnormal psychiatric behavior and cognitive impairment. The abnormal rate of imaging examination is high. Serological screening of high-risk groups of neurosyphilis is conducive to the early diagnosis of disease early treatment, neurosyphilis sub-type management of the individualized treatment of the disease may have positive significance.