摘要
目的探讨血清快速血浆反应素试验(rapid plasma reagin test,RPR)阴性梅毒患者发生神经梅毒的可能性。方法选取2015—2020年首都医科大学附属北京佑安医院皮肤科血清RPR阴性的梅毒患者,分析其临床表现、实验室检查、治疗及预后。结果共纳入血清RPR阴性的梅毒患者58例,其中男23例,女35例,年龄21~75岁,平均(43.1±12.1)岁,平均病程(5.1±1.7)年。早期梅毒患者1例(1.7%),晚期41例(70.7%),不明分期16例(27.6%);有神经系统症状患者27例(46.6%);驱梅治疗患者54例(93.1%),未经治疗4例(6.9%);重复驱梅治疗患者15例(25.9%)。腰椎穿刺结果显示,5例患者疑似神经梅毒,均出现脑脊液WBC升高,其中1例脑脊液梅毒螺旋体颗粒凝集试验(treponema pallidum particle agglutination,TPPA)阳性;3例患者出现神经系统症状,其中2例经头孢曲松强化驱梅治疗后,症状未见好转;2例在腰穿前3~6个月血清RPR阳性,RPR波动于1∶1~1∶2。结论血清RPR阴性梅毒患者发生神经梅毒的可能性较低,即使有神经系统症状,可先排除其他神经系统或相关疾病,结合近期血清RPR滴度,必要时进行脑脊液检测。
Objective To explore the possibility of neurosyphilis in patients with negative serum rapid plasma reagin test(RPR).Methods Syphilis patients with negative serum RPR in Department of Dermatology Beijing Youan Hospital from 2015 to 2020 were selected,and the clinical manifestations,laboratory examination,treatment and prognosis were analyzed.Results A total of 58 syphilis patients with negative serum RPR were included,including 23 males and 35 females,aged from 21 to 75 years,with an average of(43.1±12.1)years and an average course of(5.1±1.7)years.There was one case of early syphilis(1.7%),41 cases of late syphilis(70.7%)and 16 cases of unknown stage(27.6%).There were 27 patients with nervous system symptoms(46.6%).54 cases(93.1%)were treated by expelling plum,and four cases(6.9%)were untreated.15 cases(25.9%)were treated with repeated anti-syphilis treatment.The results of lumbar puncture showed that five patients were suspected of neurosyphilis,and all of them had elevated WBC in cerebrospinal fluid,one patient was positive for treponema pallidum particle agglutination(TPPA).Three patients developed nervous system symptoms,of which two patients did not get better after intensive treatment with ceftriaxone.Two patients had positive serum RPR 3-6 months before lumbar puncture,and the RPR fluctuated from 1:1-1:2.Conclusions Patients with serum RPR negative syphilis are less likely to develop neurosyphilis,even if they have nervous system symptoms,other nervous system or related diseases should be ruled out first,and cerebrospinal fluid should be detected if necessary in combination with the recent serum RPR titer.
作者
崔文颖
翁文佳
闫俊玲
高艳青
Cui Wenying;Weng Wenjia;Yan Junling;Gao Yanqing(Department of Dermatology,Beijing Youan Hospital,Capital Medical University,Beijing 100069,China)
出处
《北京医学》
CAS
2023年第10期862-865,共4页
Beijing Medical Journal
作者简介
通信作者:高艳青,Email:gyqing2001bj@sina.com
