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| 87例神经梅毒患者临床及实验室特征分析 |
| Clinical and laboratory characteristics of 87 patients with neurosyphilis |
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| DOI：10.3969/j.issn.1007-8134.2019.05.004 |
| 中文关键词: 神经梅毒 有症状 无症状 |
| 英文关键词: neurosyphilis symptomatic asymptomatic |
| 基金项目:北京市医院管理局青苗人才培养计划（QML20181701） |
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| 中文摘要: |
| 目的 分析87例神经梅毒患者的临床及实验室特征。方法 回顾性总结分析87例HIV阴性的神经梅毒患者发病年龄、临床症状、脑脊液检查（包括脑脊液白细胞计数、蛋白定量）、快速血浆反应素环状卡片试验（rapid plasma reagent test, RPR）、梅毒螺旋体明胶颗粒凝集试验（treponema pallidum particle assay, TPPA）、梅毒荧光抗体吸收试验（fluorescent treponemal antibody absorption test, FTA-ABS）等资料。结果 87例神经梅毒患者中有症状神经梅毒患者54例（62.1%），其中眼部受损者最多见；无症状患者33例（37.9%）。 87例患者中脑脊液白细胞异常率为82.8%，脑脊液蛋白异常率为44.8%，脑脊液RPR的异常率为44.8%，脑脊液TPPA阳性率为80.5%，脑脊液FTA-ABS IgG抗体阳性率为87.4%、IgM抗体阳性率为3.4%。有症状患者与无症状患者脑脊液RPR、白细胞计数和蛋白定量，差异均无统计学意义（P均＞0.05）。有症状患者脑脊液FTA-ABS IgG抗体阳性率为94.4%，IgM抗体阳性率为3.7%。结论 有症状神经梅毒患者中眼部受损者多见，临床医生对有眼部损害的梅毒患者须警惕神经梅毒的可能。神经梅毒患者中脑脊液RPR检测阳性率较低，脑脊液RPR在诊断神经梅毒中的作用仍需要大样本研究进一步证实。有症状神经梅毒患者脑脊液FTA-ABS抗体阴性不能排除神经梅毒。 |
| 英文摘要: |
| Objective To analyze the clinical and laboratory features of neurosyphilis in 87 patients. Methods The onset age, clinical symptoms, cerebrospinal fluid examination (including cerebrospinal fluid white blood cell count, protein quantification), rapid plasma reagent test (RPR), treponema pallidum particle assay (TPPA) and fluorescent treponemal antibody absorption test (FTA-ABS) results of 87 HIV negative neurosyphilis patients were analyzed, retrospectively. Results Among 87 patients, 54 cases (62.1%) had symptomatic neurosyphilis and ocular lesions were dominant, and 33 cases (37.9%) had asymptomatic neurosyphilis. The cerebrospinal fluid leukocyte abnormal rate was 82.8%, cerebrospinal fluid protein abnormal rate was 44.8%; cerebrospinal fluid RPR abnormal rate was 44.8%, cerebrospinal fluid TPPA positive rate was 80.5%, cerebrospinal fluid FTA-ABS IgG antibody positive rate was 87.4%, and IgM antibody positive rate was 3.4%. There were no significant differences in RPR, white blood cell count and protein quantification between symptomatic patients and asymptomatic patients (P＞0.05). The positive rate of FTA-ABS IgG antibody was 94.4% and the positive rate of IgM antibody was 3.7% in patients with symptomatic neurosyphilis. Conclusions The patients with symptomatic neurosyphilis are prone to have ocular damage. Clinicians should be alert to the possibility of neurosyphilis in syphilis patients with ocular damage. The positive rate of cerebrospinal fluid RPR test in patients with neurosyphilis is low. The role of cerebrospinal fluid RPR in the diagnosis of neurosyphilis still requires large-sample study for further confirmation. Neurosyphilis can not be ruled out for symptomatic neurosyphilis patients with negative FTA-ABS antibody. |
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