麻痹性痴呆型神经梅毒的临床特征和预后分析
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摘要
目的探求麻痹性痴呆型神经梅毒患者的临床特征和预后。方法 2008年9月至2013年8月,首都医科大学附属北京地坛医院收治了28例确诊艾滋病病毒阴性的成人麻痹性痴呆型神经梅毒患者,回顾性分析这些病人的临床资料。结果 28例麻痹性痴呆型神经梅毒患者中,首发症状为精神行为异常8例(28.57%),言语不利7例(25.00%),记忆力下降6例(21.43%);经过临床评估后存在认知障碍的患者有24例(85.71%),存在精神行为异常的22例(78.57%);肌张力增高4例(14.29%),肌力下降4例(14.29%)等;20例行头颅核磁检查者,均存在不同程度异常,其中脑萎缩9例(45.00%)。28例患者经过住院正规神经梅毒治疗后,出院时23例患者临床症状减轻。随访有不同程度的血清梅毒甲苯胺红不加热血清试验(TRUST)滴度下降,脑脊液TRUST滴度下降,脑脊液白细胞下降,脑脊液蛋白含量下降。结论认知障碍和精神行为异常是麻痹性痴呆型神经梅毒的主要临床表现,有很高误诊率,临床医师应引起重视。
Objective To explore the clinical features and prognosis in the patients of general paresis.MethodsRetrospective analysis was made based on the clinical and laboratory data,including the first and major clinical symptoms and signs,blood and CSF(cerebrospinal fluid)test results,the treatment and outcomes in the neurosyphilis patients with general paresis hospitalized in Ditan hospital from Sept 2008 to Aug 2013.Results The most common initial symptoms of general paresis patients were psychiatric and behavior disorder(28.57%),followed by language abnormalities(25.00%),and impaired memory(21.43%).After clinical evaluation,it was found that the main symptoms included cognitive impairment(85.71%),psychiatric-behavior disorders(78.57%),hypermyotonia(14.29%),and muscle weakness(14.29%).20 of 28 patients had MRI abnormalities,and encephalatrophy(32.14%)was the most common.23 of 28 patients had clinical improvement,and blood TRUST,CSF TRUST,CSF WBC(cerebrospinal fluid-white blood cell)and CSF protein decreased in the fellow-up.Conclusion Psychiatric and behavior disorder and cognitive impairment are the main symptoms of general paresis patients and the misdiagnosis rate is high.We should pay attention to the symptoms,and ensure general paresis patients to be diagnosed and treated timely and correctly.
Objective To explore the clinical features and prognosis in the patients of general paresis.MethodsRetrospective analysis was made based on the clinical and laboratory data,including the first and major clinical symptoms and signs,blood and CSF(cerebrospinal fluid)test results,the treatment and outcomes in the neurosyphilis patients with general paresis hospitalized in Ditan hospital from Sept 2008 to Aug 2013.Results The most common initial symptoms of general paresis patients were psychiatric and behavior disorder(28.57%),followed by language abnormalities(25.00%),and impaired memory(21.43%).After clinical evaluation,it was found that the main symptoms included cognitive impairment(85.71%),psychiatric-behavior disorders(78.57%),hypermyotonia(14.29%),and muscle weakness(14.29%).20 of 28 patients had MRI abnormalities,and encephalatrophy(32.14%)was the most common.23 of 28 patients had clinical improvement,and blood TRUST,CSF TRUST,CSF WBC(cerebrospinal fluid-white blood cell)and CSF protein decreased in the fellow-up.Conclusion Psychiatric and behavior disorder and cognitive impairment are the main symptoms of general paresis patients and the misdiagnosis rate is high.We should pay attention to the symptoms,and ensure general paresis patients to be diagnosed and treated timely and correctly.
引文
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[4]李满棠,黄波,李刚.麻痹性痴呆46例临床分析[J].广东医学院学报,2016,34(6):658-660.
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[7]吴李硕,罗文静,黄文,等.麻痹性痴呆12例分析[J].中国神经免疫学和神经病学杂志,2014,21(2):98-101.
[8]Ghanem KG.REVIEW:Neurosyphilis:A historical perspective and review[J].CNS neuroscience&therapeutics,2010,16(5):e157-e168.
[9]张校明,钟晓波,黄亚琳,等.麻痹性痴呆误诊的原因分析[J].神经疾病与精神卫生,2009,9(2):131-133.
[10]周晖,吴谷茸,廖绮曼,等.麻痹性痴呆临床特点和预后——附10例临床分析[J].临床皮肤科杂志,2011,40(7):394-395.
[11]Pastuszczak M,Zeman J,Jaworek AK,et al.Cerebrospinal fluid abnormalities in HIV-negative patients with secondary and early latent syphilis and serum VDRL≥1:32[J].Indian journal of dermatology,2013,58(4):325.
[12]黄宇明,姜美娟,许东梅,等.梅毒晚期麻痹性痴呆患者的脑电图特征分析[J].中华实验和临床感染病杂志(电子版),2014,8(6):789-792.
[13]Rao A,Khan A,Singh K,et al.Neurosyphilis:An Uncommon Cause of Dementia[J].Journal of the American Geriatrics Society,2015,63(8):1710-1712.
[14]魏春波,伦文辉,万钢.有症状神经梅毒危险因素Logistic回归分析[J].中华实验和临床感染病杂志(电子版),2014,8(4):545-547.
[15]魏春波,伦文辉,万钢.有症状与无症状神经梅毒患者临床及实验室特征的比较[J].中华实验和临床感染病杂志(电子版),2013,7(3):391-394.
[16]郑东,林建荣,彭良富,等.青霉素治疗麻痹性痴呆预后观察[J].中国神经精神疾病杂志,2008,34(8):493-495.
[2]Sabre L,Braschinsky M,Taba P.Neurosyphilis as a great imitator:a case report[J].BMC Research Notes,2016,9(1):372.
[3]Tong ML,Lin LR,Zhang HL,et al.Spectrum and characterization of movement disorders secondary toneurosyphilis[J].Parkinsonism&related disorders,2013,19(4):441-445.
[4]李满棠,黄波,李刚.麻痹性痴呆46例临床分析[J].广东医学院学报,2016,34(6):658-660.
[5]Workowski KA,Berman SM.Sexually transmitted diseases treatment guidelines,2006[J].Morb Mortal Wkly Rep,2006,55(1):22-30.
[6]Berger JR,Dean D.Neurosyphilis[J].Handbook of clinical neurology,2013,121:1461-1472.
[7]吴李硕,罗文静,黄文,等.麻痹性痴呆12例分析[J].中国神经免疫学和神经病学杂志,2014,21(2):98-101.
[8]Ghanem KG.REVIEW:Neurosyphilis:A historical perspective and review[J].CNS neuroscience&therapeutics,2010,16(5):e157-e168.
[9]张校明,钟晓波,黄亚琳,等.麻痹性痴呆误诊的原因分析[J].神经疾病与精神卫生,2009,9(2):131-133.
[10]周晖,吴谷茸,廖绮曼,等.麻痹性痴呆临床特点和预后——附10例临床分析[J].临床皮肤科杂志,2011,40(7):394-395.
[11]Pastuszczak M,Zeman J,Jaworek AK,et al.Cerebrospinal fluid abnormalities in HIV-negative patients with secondary and early latent syphilis and serum VDRL≥1:32[J].Indian journal of dermatology,2013,58(4):325.
[12]黄宇明,姜美娟,许东梅,等.梅毒晚期麻痹性痴呆患者的脑电图特征分析[J].中华实验和临床感染病杂志(电子版),2014,8(6):789-792.
[13]Rao A,Khan A,Singh K,et al.Neurosyphilis:An Uncommon Cause of Dementia[J].Journal of the American Geriatrics Society,2015,63(8):1710-1712.
[14]魏春波,伦文辉,万钢.有症状神经梅毒危险因素Logistic回归分析[J].中华实验和临床感染病杂志(电子版),2014,8(4):545-547.
[15]魏春波,伦文辉,万钢.有症状与无症状神经梅毒患者临床及实验室特征的比较[J].中华实验和临床感染病杂志(电子版),2013,7(3):391-394.
[16]郑东,林建荣,彭良富,等.青霉素治疗麻痹性痴呆预后观察[J].中国神经精神疾病杂志,2008,34(8):493-495.