中国医学创新
中國醫學創新
중국의학창신
Medical Innovation of China
2015年
29期
136-138
,共3页
神经梅毒%麻痹性痴呆%脑卒中%癫痫
神經梅毒%痳痺性癡呆%腦卒中%癲癇
신경매독%마비성치태%뇌졸중%전간
Neurosyphilis%Dementia%Stroke%Epilepsy
目的：分析23例神经梅毒的临床特征、实验室检查、影像学表现及诊治方法，提高对神经梅毒的认识。方法：收集2009年5月-2015年4月在扬州市第一人民医院神经内科住院且诊断为神经梅毒的患者23例，回顾性分析患者的临床表现、实验室检查结果及影像学特征等，探讨神经梅毒的治疗方法。结果：所有患者血清快速血浆反应素试验（RPR）和梅毒螺旋体抗原凝集试验（TPPA）检查均阳性，21例完成腰穿脑脊液检查RPR和TPPA均阳性，6例脑脊液细胞轻度增多，12例脑脊液蛋白有所增高，5例脑脊液蛋白细胞均正常。临床表现为痴呆的6例，伴有脑卒中11例，神经痛2例，癫痫发作2例，视神经炎1例，共济失调1例。头颅影像学检查无特异性，部分表现为脑梗死、脑萎缩、脑室扩大，不同程度脑白质变性、树胶样异常信号或脑回强化等。所有患者接受青霉素或头孢曲松治疗后，神经梅毒症状较前明显改善。结论：神经梅毒临床表现复杂多样，部分隐匿但危害大，联合血液学、脑脊液及影像学检查有助于临床诊断，及时合理的抗梅毒治疗可以改善预后。
目的：分析23例神經梅毒的臨床特徵、實驗室檢查、影像學錶現及診治方法，提高對神經梅毒的認識。方法：收集2009年5月-2015年4月在颺州市第一人民醫院神經內科住院且診斷為神經梅毒的患者23例，迴顧性分析患者的臨床錶現、實驗室檢查結果及影像學特徵等，探討神經梅毒的治療方法。結果：所有患者血清快速血漿反應素試驗（RPR）和梅毒螺鏇體抗原凝集試驗（TPPA）檢查均暘性，21例完成腰穿腦脊液檢查RPR和TPPA均暘性，6例腦脊液細胞輕度增多，12例腦脊液蛋白有所增高，5例腦脊液蛋白細胞均正常。臨床錶現為癡呆的6例，伴有腦卒中11例，神經痛2例，癲癇髮作2例，視神經炎1例，共濟失調1例。頭顱影像學檢查無特異性，部分錶現為腦梗死、腦萎縮、腦室擴大，不同程度腦白質變性、樹膠樣異常信號或腦迴彊化等。所有患者接受青黴素或頭孢麯鬆治療後，神經梅毒癥狀較前明顯改善。結論：神經梅毒臨床錶現複雜多樣，部分隱匿但危害大，聯閤血液學、腦脊液及影像學檢查有助于臨床診斷，及時閤理的抗梅毒治療可以改善預後。
목적：분석23례신경매독적림상특정、실험실검사、영상학표현급진치방법，제고대신경매독적인식。방법：수집2009년5월-2015년4월재양주시제일인민의원신경내과주원차진단위신경매독적환자23례，회고성분석환자적림상표현、실험실검사결과급영상학특정등，탐토신경매독적치료방법。결과：소유환자혈청쾌속혈장반응소시험（RPR）화매독라선체항원응집시험（TPPA）검사균양성，21례완성요천뇌척액검사RPR화TPPA균양성，6례뇌척액세포경도증다，12례뇌척액단백유소증고，5례뇌척액단백세포균정상。림상표현위치태적6례，반유뇌졸중11례，신경통2례，전간발작2례，시신경염1례，공제실조1례。두로영상학검사무특이성，부분표현위뇌경사、뇌위축、뇌실확대，불동정도뇌백질변성、수효양이상신호혹뇌회강화등。소유환자접수청매소혹두포곡송치료후，신경매독증상교전명현개선。결론：신경매독림상표현복잡다양，부분은닉단위해대，연합혈액학、뇌척액급영상학검사유조우림상진단，급시합리적항매독치료가이개선예후。
Objective:To analyze the clinical features, laboratory examination,imaging characteristics and diagnosis method of neurosyphilis.Method:23 patients with neurosyphilis were selected in No.1 People’s Hospital of Yangzhou from May 2009 to April 2015,the clinical features,laboratory examination, imaging characteristics, diagnosis and treatment of neurosyphilis were retrospectively analyzed.Result:The serum RPR and TPPA of all patients were positive,21 patients were positive with cerebrospinal fluid RPR and TPPA, 6 cases of cerebrospinal cell count increased,12 cases of the cerebrospinal fluid protein increased,the cerebrospinal fluid protein and white cell count was nomal had 5 cases.Among the 23 patients, 6 patients suffered dementia,11 cases suffered cerebral apoplexy,2 cases were neuralgia, 2 cases were epilepsy, 1 case was optic neuritis and 1 case was ataxia. The patients were no specifity MRI scanning,part of them showed cerebral infarctions,encephalatrophy,ventriculomegaly, varying degrees of cerebral white matter degeneration, gummatous abnormal signal or gyri enhancement and so on. Most of the patients showed obvious improvement in the symptoms after treated with penicillin or ceftriaxone.Conclusion: Neurosyphilis clinical manifestations are diverse and complex, part of them hidden but harm, combined with blood science, cerebrospinal fluid, and imaging examination are helpful to clinical diagnosis, timely and reasonable anti syphilis treatment can improve the prognosis.
