發(fā)布時間：2018-04-10 13:03

  本文選題：神經梅毒 + 梅毒螺旋體��； 參考：《青島大學》2017年碩士論文

【摘要】：目的:分析2000年-2016年于青島大學附屬醫(yī)院及中山大學一附院住院治療的53例神經梅毒患者的臨床特點,為臨床醫(yī)生提供參考。方法:參考2010年美國疾病控制中心(Centers for Disease Control and Prevention,CDC)神經梅毒診斷標準,回顧分析2000年-2016年于青島大學附屬醫(yī)院及中山大學一附院住院治療的53例神經梅毒患者的臨床資料,包括患者性別、年齡、冶游史等病史情況,也包括神經梅毒患者的臨床癥狀與體征、實驗室檢查、影像學檢查結果。結果:(1)共有53例患者符合入組標準,包括46例男性及7例女性,除了一例為越南人外,均為中國人。發(fā)病年齡范圍為20歲-80歲(平均發(fā)病年齡為48.51歲)。(2)最常見的臨床類型是腦膜血管型神經梅毒(35.85%),其次是麻痹性癡呆(28.30%),腦膜型神經梅毒(11.32%)、脊髓癆(7.55%)、梅毒性脊髓脊膜炎(9.43%)、無癥狀神經梅毒(7.55%)。最常見的首發(fā)癥狀為肢體乏力(34%)。(3)入組神經梅毒患者進行了血清梅毒螺旋體明膠顆粒凝集試驗(treponema pallidum particleagglutination,TPPA)檢查及血清人類免疫缺陷病毒(human immunodeficiency virus,HIV)抗體檢查,53例患者均為血清TPPA陽性及HIV陰性。53例神經梅毒患者進行了腦脊液(Cerebrospinal Fluid,CSF)常規(guī)檢查,20例出現(xiàn)CSF白細胞升高,出現(xiàn)33例CSF蛋白升高,同時出現(xiàn)CSF白細胞升高及蛋白升高者19例;(4)40例神經梅毒患者行顱腦顱腦核磁共振檢查磁共振成像(Nuclear Magnetic Resonance Imaging,MRI)其中7例顱腦MRI無異常表現(xiàn),33例神經梅毒患者(包括腦膜型神經梅毒1例脊髓脊膜型神經梅毒3例腦膜血管型神經梅毒17例麻痹性癡呆11例脊髓癆1例)顱腦MRI出現(xiàn)異常表現(xiàn),包括卒中樣表現(xiàn)、腦萎縮表現(xiàn)及白質異常信號等,最主要的影像學改變?yōu)楣Ｋ涝罡淖?共有20例。5例神經梅毒患者進行了腦電圖檢查,2例出現(xiàn)異常的腦電圖改變,一例表現(xiàn)為癲癇樣放電,一例表現(xiàn)為背景慢波活動,2名患者均為麻痹性癡呆患者。結論:1.53例神經梅毒患者中,最常見的神經梅毒臨床分型為腦膜血管型神經梅毒,臨床模式已出現(xiàn)明顯改變。2.53例神經梅毒患者中出現(xiàn)了較多的漏診、誤診現(xiàn)象,血清學檢查、腦脊液檢查、影像學檢查均無特異性。臨床診斷神經梅毒時,需綜合流行病學、臨床表現(xiàn)、實驗室檢查及影像學檢查進行綜合判斷。3.每個具有神經精神癥狀但沒有明確原因的患者均應進行梅毒血清學檢查。當梅毒血清學檢查陽性時,患者應進行腦脊液檢查,以免漏診、誤診,影響預后。
[Abstract]:Objective: to analyze the clinical characteristics of 53 cases of neurosyphilis hospitalized in affiliated Hospital of Qingdao University and the first affiliated Hospital of Sun Yat-sen University from 2000 to 2016 so as to provide reference for clinicians.Methods: the clinical data of 53 neurosyphilis patients who were hospitalized in Qingdao University affiliated Hospital and Sun Yat-sen University first affiliated Hospital from 2000 to 2016 were retrospectively analyzed with reference to the criteria for diagnosis of neurosyphilis by Centers for Disease Control and PreventionCDCin 2010.It includes patient's gender, age, history of travel, clinical symptoms and signs of neurosyphilis, laboratory examination and imaging results.Results A total of 53 patients, including 46 males and 7 females, were all Chinese except one Vietnamese.9.43% and 7.55% of asymptomatic neurosyphilis.The most common initial symptom was limb asthenia 34. The patients with neurosyphilis were examined by serum treponema pallidum particle agglutination test and serum human immunodeficiency virus immunodeficiency virus) antibody test. 53 patients were all blood samples from the patients with neurosyphilis who were treated with treponema pallidum particle agglutination test (TPPA) and human immunodeficiency virus virus virus (HIV) antibody test.Serum TPPA positive and HIV negative. 53 patients with neurosyphilis were examined with Cerebrospinal fluid fluid (CSF) in 20 cases with CSF leukocytosis.CSF protein increased in 33 cases.CSF leucocyte and protein were increased in 19 patients with neurosyphilis and 40 patients with neurosyphilis were examined by magnetic resonance imaging (MRI), 7 of them had no abnormal manifestations of MRI in the brain (including 33 patients with neurosyphilis).1 case of membranous neurosyphilis 1 case of spinal meningeal neurosyphilis 3 cases of meningeal vascular type neurosyphilis 17 cases of paralytic dementia 11 cases of tuberculosis) craniocerebral MRI abnormal manifestation.Including apoplexy, cerebral atrophy and abnormal white matter signals, the most important imaging changes were infarction. A total of 20 patients with neurosyphilis underwent electroencephalogram (EEG) examination, 2 of them showed abnormal EEG changes.One case showed epileptiform discharge and one case showed background slow wave activity. Two patients were all paralytic dementia.Conclusion among 1.53 patients with neurosyphilis, the most common type of neurosyphilis is meningeal vascular neurosyphilis.Cerebrospinal fluid examination and imaging examination were not specific.In clinical diagnosis of neurosyphilis, comprehensive epidemiological, clinical manifestations, laboratory examination and imaging examination are needed to make a comprehensive judgment. 3.Syphilis serology should be performed on every patient with neuropsychiatric symptoms but no definite cause.When syphilis serological examination is positive, the patient should have cerebrospinal fluid examination to avoid missed diagnosis, misdiagnosis and influence prognosis.
【學位授予單位】：青島大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R759.13

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本文編號：1731310