摘要：

目的: 探讨神经梅毒患者的临床特点、血清及脑脊液梅毒螺旋体抗体检测结果、非特异性影像学改变特点。方法: 回顾分析2016年1月至2024年1月华东师范大学附属芜湖医院诊断与治疗的31例梅毒患者, 收集患者临床、实验室及头部影像学资料并进行非特异性影像学改变分析, 包括全脑皮质萎缩-额叶量表(GCA-F)、后部皮质萎缩量表(PCA)、脑白质高信号Fazekas量表和埃文斯指数(EI)。结果: 根据是否诊断为神经梅毒分为神经梅毒组(23例)和非神经梅毒组(8例)。与非神经梅毒组相比, 神经梅毒组男性占比较高(Fisher确切概率法: P=0.043), 血清甲苯胺红不加热血清试验(TRUST)滴度(Z=-3.708, P=0.000)、脑脊液白细胞计数(Z=-3.930, P=0.000)、脑脊液蛋白定量(Z=-3.250, P=0.001)、脑脊液TRUST滴度(Z=-3.934, P=0.000)较高。神经梅毒组与非神经梅毒组头部非特异性影像学改变视觉评估GCA-F评分、PCA评分、脑室旁白质高信号Fazekas评分、脑深部白质高信号Fazekas评分和EI指数差异无统计学意义(均P > 0.05)。结论: 神经梅毒好发于男性, 血清TRUST滴度高, 脑脊液白细胞计数、蛋白定量和TRUST滴度高的梅毒患者应警惕神经梅毒之可能。神经梅毒患者在脑白质高信号、额叶萎缩、后部皮质萎缩、脑室扩大方面无特异性改变。

关键词: 神经梅毒, 脑脊髓液, 血清, 磁共振成像

Abstract:

Objective: To investigate the clinical manifestations, laboratory examination, and non-specific imaging changes in patients with neurosyphilis (NS). Methods: The clinical laboratory and brain MRI data of 31 patients with syphilis from January 2016 to January 2024 was collected in Affiliated Hospital, East China Normal University. The non-specific imaging changes were assessed by the rating scales included Global Cortical Atrophy-Frontal Subscale (GCA-F), Posterior Cortical Atrophy (PCA), white matter hyperintensity the Fazekas scale, and Evans Index (EI). Results: There was 23 patients enrolled in the neurosyphilis group and 8 in the non-neurosyphilis group. Compared with the non-neurosyphilis group, the neurosyphilis group had a higher proportion of male patients (Fisher's exact probability: P=0.043), as well as significantly elevated serum toluidine red unheated serum test (TRUST) titers (Z=-3.708, P=0.000), cerebrospinal fluid (CSF) white blood cell counts (Z=-3.930, P=0.000), CSF protein (Z=-3.250, P=0.001) and CSF TRUST titers (Z=-3.934, P=0.000). No statistically significant differences were observed between the 2 groups in the non-specific imaging changes, including the GCA-F score, PCA score, Fazekas scores for periventricular white matter hyperintense (PWMH) and deep brain white matter hyperintense (DWMH), as well as the EI (P > 0.05, for all). Conclusions: Neurosyphilis is prevalent in males. Patients with high serum TRUST titers, high CSF white blood cell counts, high CSF protein, and high CSF TRUST titers are more likely to develop neurosyphilis. Patients with neurosyphilis have nonspecific changes in white matter hyperintensity, frontal lobe atrophy, posterior cortical atrophy, and ventricular enlargement.

Key words: Neurosyphilis, Cerebrospinal fluid, Serum, Magnetic resonance imaging

中图分类号: 

• R741