| Objective:This article collects the clinical data of the inpatients diagnosed as neurosyphilis,including general condition,clinical features,experiment Laboratory examination and imaging features,statistical analysis and follow-up of the obtained data,in order to find the deficiencies in the diagnosis and treatment.This paper puts forward some suggestions and measures that can improve the diagnosis rate,cure rate and reduce the misdiagnosis and missed diagnosis rate.Further strengthen prevention,monitoring and treatment.Methods:Through the inpatient medical record information system,the digital medical record retrieval system in the medical record room,and the Donghua electronic medical record filing management system,inpatients diagnosed with neurosyphilis in the dermatology and neurology department of Anhui Provincial Hospital affiliated to Anhui Medical University were screened out.The hospitalized date was distributed from January 2015 to October 2020.Some patients have 2-3 hospitalization experiences.These data were collected and analyzed.Results:In this study,78 patients(included 50 males and 28 females)with neurosyphilis were included.The ratio of Male to female was approximately1.8:1,with an age of(53.28±12.88)years old.Besides,54 patients with higher education(69.3%),and about 80.7% of patients report that they have a fixed sexual partner.Among the 78 patients,36(46.2%)samples had been accepted regular treatment of syphilis,there were 42 cases(53.8%)without treatment or without formal treatment.The average time from the diagnosis of syphilis to the diagnosis of neurosyphilis or the appearance of psychiatric symptoms to the diagnosis of neurosyphilis was 7 months(up to 30 years).Among them,43 cases(55.1%)were diagnosed with neurosyphilis after psychoneurosis.According to the imaging features,6 cases suggested demyelination of white matter,15 cases showed changes in cerebral atrophy or cerebral infarction,6 cases suggested abnormal signals in all regions of the brain,and a majority of the patients did not complete MRI brain tests.Among the enrolled patients,32 cases had no neurological symptoms,and46 cases had neurological symptoms.The number of CSF cells in symptomatic neurosyphilis patients was higher than that in asymptomatic neurosyphilis patients,but there was not statistically difference.The expression of cerebrospinal fluid protein and IGG,IGA and IGM in symptomatic neurosyphilis are higher than in asymptomatic neurosyphilis,and the difference was statistically significant.In patients with symptomatic neurosyphilis,Cerebrospinal fluid nucleated cells and IGG,IGA,IGM decreased before and after treatment,And the difference was statistically significant,Cerebrospinal fluid protein decreased after treatment,but the difference was not statistically significant.In the asymptomatic neurosyphilis group,the number of cerebrospinal fluid nucleated cells and IGM decreased before and after treatment,and the difference was statistically significant;The number of cerebrospinal fluid protein,IGG and IGA were decreased after treatment,but the difference was not statistically significant.When patients with neurological symptoms was diagnosed as neurosyphilis,the serum TRUST titer was 1:1 to 1:128,with a median of 1:16;The cerebrospinal fluid TRUST titer was negative to 1:32,and the median was 1:2.When an asymptomatic patient was diagnosed as neurosyphilis,the serum TRUST titer was 1:2 to 1:64,with a median of 1:32;the cerebrospinal fluid TRUST titer was negative to 1:8,and the median was 1:2.After the treatment of 18 patients with neurological symptoms,the serum TRUST titer was decreased in 13 cases,and 4 cases showed no significantly change.Besides,the serum TRUST titer of 1 case was increased,but the cerebrospinal fluid TRUST titer turned negative,and the blood TRUST was downregulated rechecked afterwards;14 cases of the cerebrospinal fluid TRUST titer turned negative,2 cases decreased,and 2 cases remained unchanged.After treatment of 15 patients with no neurological symptoms,14 cases of serum and cerebrospinal fluid TRUST had a negative or decreased titer.Besides,the serum TRUST of one patient was maintained at 1:16 after received three regular exorcisms;The cerebrospinal fluid TRUST drops from 1:2 to negative after secondary treatment,and we still performed the third treatment for it.Conclusion:With the increasing number of patients with neurosyphilis in our country.Most patients with neurosyphilis have not received regular treatment or have failed syphilis treatment before the onset of syphilis.The age of onset of neurosyphilis is mainly middle-aged,and the main types are asymptomatic neurosyphilis and paralytic dementia.TRUST,albumin,white blood cells,immunoglobulin TPPA,imaging examination and neurological symptoms in the cerebrospinal fluid can be used as the basis for the diagnosis of neurosyphilis.All the above except TPPA can be used for the judgment of neurosyphilis after recovery.If a patient with syphilis has mental symptoms or treatment fails,a lumbar puncture and cerebrospinal fluid examination should be performed.The young and middle-aged who have neurological symptoms for unobvious reasons should be checked for syphilis and neurosyphilis in time.Early diagnosis and regular treatment are conducive to the clinical and laboratory cure of neurosyphilis. |
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