摘要：

目的 总结梅毒性视神经炎临床特点和病理生理学机制。方法 回顾分析12 例梅毒性视神经炎患者的临床症状与体征、实验室检查、电生理学检查、影像学检查、治疗及预后。结果 12 例患者（18 只眼）均以视力下降为主要表现，呈急性或亚急性起病，呈单眼或双眼先后发病，视力损害程度不尽一致，伴视野缺损、眼底改变；脑脊液白细胞计数增加、蛋白定量升高；血清快速血浆反应素试验（RPR）和梅毒螺旋体血凝试验（TPHA）阳性，脑脊液RPR 试验/甲苯胺红不加热血清试验和TPHA 试验阳性；视觉诱发电位P100 波潜伏期延长、波幅降低；MRI 显示视神经萎缩、视神经眶内段或视神经全长异常信号；予水剂青霉素静脉滴注和苄星青霉素肌肉注射后视力好转。结论 神经梅毒作为视神经炎的病因临床并不常见，应注意与特发性视神经炎和缺血性视神经病变相鉴别，梅毒血清学和脑脊液检测有助于诊断，早期诊断和规范治疗对视力恢复至关重要。

关键词: 视神经炎, 神经梅毒, 血清学试验, 脑脊髓液

Abstract:

Objective  To explore the clinical characteristics and pathophysiological mechanism of syphilitic optic neuritis.  Methods  The clinical signs and symptoms, laboratory tests, electrophysiological examinations, imaging features, treatment and prognosis of 12 cases with syphilitic optic neuritis admitted in our hospital from January 2014 to March 2016 were retrospectively analyzed.  Results  The main clinical manifestation was vision loss in 12 patients (18 eyes), with acute or subacute onset, monocular attack or one after other. Degrees of visual loss differed among these patients. They also presented visual field defect and ocular fundus changes. Cerebrospinal fluid (CSF) examination showed increased white blood cell and protein. Rapid plasma reagin (RPR) assay and Treponema pallidum hemagglutination assay (TPHA) in serum were positive. RPR assay/toluidine red unheated serum test (TRUST) and TPHA in CSF were positive. Visual-evoked potential (VEP) showed prolonged latency and declined amplitude of P100 wave. MRI revealed optic atrophy, abnormal signs in medial orbital part or overall length of optic nerve. The vision was improved after intravenous injection of aqueous penicillin and muscular injection of benzathine benzylpenicillin.  Conclusions  Neurosyphilis is a rare cause of optic neuritis. Differential diagnosis should be paid attention on syphilitic optic neuritis from idiopathic optic neuritis and ischemic optic neuropathy. Serologic test and CSF examination will be helpful for a clear diagnosis. Besides, early diagnosis and standard therapy are essential for vision recovery.

Key words: Optic neuritis, Neurosyphilis, Serologic tests, Cerebrospinal fluid