摘要
梅毒是我国最常见的性传播疾病之一,神经梅毒为最严重、最常见的梅毒并发症。中国疾病预防控制中心性病控制中心报告2014年至2019年中国梅毒发病率由2014年的30.93/10万增长至2019年的38.37/10万,呈逐年上升趋势;神经梅毒的发病率也随之增长。神经梅毒是梅毒螺旋体侵入神经系统所引起的脑、脊髓及周围神经损害的慢性感染性疾病,可出现于各期梅毒病程,一般认为,未经治疗的梅毒患者约20%可发展为无症状神经梅毒,后者中10%可进展为有症状神经梅毒。目前神经梅毒诊断尚无金标准,需依据患者病史、症状、体征、实验室、电生理、神经心理及神经影像等进行综合分析。目前用于治疗神经梅毒的抗菌药物包括β-内酰胺类、四环素类及大环内酯类,以青霉素为首选。神经梅毒药物治疗能否成功主要取决于抗菌药物在脑脊液中的有效浓度及维持时间,杀灭梅毒螺旋体所需脑脊液中青霉素浓度应>0.018 mg/L。神经梅毒推荐方案:青霉素1800~2400万U/d,静脉滴注(300~400万U/次,1次/4 h),连续10~14 d,继以苄星青霉素,240万U/周、肌肉注射、连用3次;或普鲁卡因青霉素240万U/d、肌肉注射、1次/d,同时口服丙磺舒,0.5 g/次、4次/d、共10~14 d,继以苄星青霉素,240万U/周、肌肉注射、连用3次。多学科协作治疗可有效改善患者精神症状及全身症状,对神经梅毒患者康复具有重要意义。糖皮质激素是否适合神经梅毒治疗,有待商榷;丙种球蛋白治疗神经梅毒的适应证、用药频次及疗效尚待进一步探讨。
Syphilis is one of the most common sexually transmitted diseases in China,and neurosyphilis is the most serious and common complication of syphilis.According to the report from National Center for Sexually Transmitted Diseases Control,Chinese Center for Disease Control and Prevention,the incidence of syphilis in China increased year by year from 2014 to 2019,which increased from 30.93/100000 in 2014 to 38.37/100000 in 2019,and the incidence of neurosyphilis was also increasing with a rising trend.Neurosyphilis is a chronic infectious disease caused by treponema pallidum invasion of brain,spinal cord and peripheral nerve and may occur in every stage of syphilis,it is generally believed that about 20%of untreated syphilis patients will develop asymptomatic neurosyphilis eventually and 10%of asymptomatic neurosyphilis may furtherly progress to symptomatic neurosyphilis.At present,there is no golden standard for the diagnosis of neurosyphilis,and the diagnosis of neurosyphilis depends on a comprehensive analysis of the patient’s medical history,symptoms,signs,laboratory,electrophysiology,neuropsychology and neuroimaging.Antibiotics currently used in clinical treatment of neurosyphilis includeβ-lactam,tetracycline and macrolides,and penicillin is the first choice.The success of neurosyphilis drug treatment mainly depends on the effective concentration and maintenance period of antibiotics in cerebrospinal fluid,and the concentration of penicillin should be higher than 0.018 mg/L toeliminate treponema pallidum in cerebrospinal fluid.Recommended regimen for neurosyphilis:aqueous crystalline penicillin G 18-24 million units per day,administered as 3-4 million units through intravenous injection every 4 hours for 10-14 days,followed by benzathine penicillin,2.4 million units per week,intramuscular injection for 3 weeks;Or Procaine penicillin G 2.4 million units intramuscular injection once daily plus Probenecid 500 mg orally 4 times/day,both for 10-14 days followed by benzathine penicillin,2.4 million units per week,intramuscular injection for 3 weeks.Multidisciplinary collaboration is of great significance for the early rehabilitation of patients with neurosyphilis,which can effectively improve the patients’mental and systemic symptoms.The applicability of glucocorticoids in the treatment of neurosyphilis remains to be discussed.And the indications,frequency and efficacy of gamma globulin in neurosyphilis patients need to be furtherly studied.
作者
许东梅
马小扬
黄宇明
Dongmei Xu;Xiaoyang Ma;Yuming Huang(National Center for Infectious Diseases,Beijing 100015,China;Department of Neurology,Beijing Ditan Hosipital,Capital Medical University,Beijing 100015,China)
出处
《中华实验和临床感染病杂志（电子版）》
CAS
2022年第5期300-306,共7页
Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition)
基金
首都医科大学附属北京地坛医院院内科研基金"启航计划"(No.DTQH201607)
关键词
神经梅毒
诊断
抗菌药物
多学科协作治疗
Neurosyphilis
Diagnosis
Antibiotics
Multiple disciplinary treatment
作者简介
通信作者:黄宇明,Email:1142027570@qq.com
