| Objective: To understand the clinical characteristics of asymptomatic neuros yphilis,and to further explore the serology and cerebrospinal fluid examination characteristics of asymptomatic neurosyphilis and its effect of treatment and follo w-up,to improve the understanding of asymptomatic neurosyphilis.Methods:A retrospective analysis was performed on 45 patients who were discharged from our hospital from March 2013 to May 2017 diagnosised as asy mptomatic neurosyphilis.Collecting the hospitalization and follow-up data of asym ptomatic neurosyphilis,and to analyze and compare the results of serology and c erebrospinal fluid examination before and after the standardized treatment of thes e patients.Results: 1.Among the 45 patients,there were 23 females and 22 males.24 patients were between 20 to 40 years old,in which 18 in 24(75%)were femal e patients.21 patients were over 40 years old,and in which 15 out of 21 were m ale patients.The average number of patients with asymptomatic neurosyphilis in o ur hospital in recent 4 years is about 12.2.There were 31 patients with syphilis serum fixed.The serum RPR titer was less than or equal to 1:4,their RPR titer of the cerebrospinal fluid was between1:1 and 1:2.The serum RPR titer was 1:8 and their titer of the cerebrospinal flui d RPR were between 1:1 and 1:8.Serum RPR titer was 1:16 and their cerebrospi nal fluid titer was between 1:1 and 1:4.The serum RPR titer was 1:32 and their cerebrospinal fluid titer fluctuated were between 1:1 and 1:8.3.In the routinal examination of cerebrospinal fluid of 45 patients,the number of white blood cells increased was 13(28.8%),and 28 cases of protein qualitative were positive(62.2%).After six months' treatment,15 patients follow the lumb ar puncture examinations,in which 7 patients were abnormal in protein qualitativ e,4 cases were overcast.And 7 patients' CSF white cell increased,6 cases wer e normal after treatment(chi-square = 1.4,P = 1.4).4.There were 15 patients who underwent lumbar puncture after 6 months' treat ment.After treatment,there were 4 patients with no changement in serum RPR ti ter,3 cases of cerebrospinal fluid RPR were negative,and 1 case of cerebrospin al fluid RPR decreased 1 titer.2 cases titers decreased by 2 times,and the RPR of cerebrospinal fluid was both negative.5 cases of serum titer decreased by 4 ti mes,none of the RPR titer of cerebrospinal fluid was negative.The serum RPR t iter decreased in patients to 8 times and above,and the RPR titer of cerebrospin al fluid was all overcast.5.After six months,the serological examination still in the follow-up was 38 pati ents,27 patients were treated with penicillin,and the serum RPR titer decreasedby more than 4 times in 13(48%)of the patients.11 peoplec with eftriaxon e,5(45%)serum RPR fell more than 4 times,there was no statistically signific ant difference(chi-square = 0.023,P = 0.023),15 people cerebrospinal fluid exa mination results after half a year were still follow-up,10(15)cases' cerebrosp inal fluid RPR titer were negative,4 cases' cerebrospinal fluid RPR titer decreas ed,and 1 case' cerebrospinal fluid RPR increased.9 people with penicillin,6(66%)cerebrospinal fluid RPR titer were negative;6 patients with ceftriaxone,4(66%)cerebrospinal fluid RPR titer was negetive,and the difference was not s tatistically significant(chi-square=0.000,P=1.00).6.In the second phase of syphilis,5 patients serum RPR titer decreased by mor e than 4 times after half a year' treatment by penicillin,but still progressed to asymptomatic neurosyphilis during the follow-up.Conclusion: 1.Asymptomatic neurosyphilis has a gender and age difference,a nd the new cases of asymptomatic neurosyphilis in our hospital have been relati vely stable in recent years.2 In patients with asymptomatic neurosyphilis,the proportion of serum fixed pati ents was higher(69%),and the proportion of serum RPR titer which is 1:32 w as higher,accounting for 35%.There was no significant correlation between seru m RPR titer and RPR titer in cerebrospinal fluid.3.In the routine examination of cerebrospinal fluid in patients with asymptomati c neurosyphilis,the positive rate of protein qualitative experiment(62.2%)was la rger than that of white cells(28.8%).There was no significant difference in resp onse to treatment.4.After the recommended treatment of asymptomatic neurosyphilis,after six mon ths' treatment,serum RPR drops fell less than or equal to 4 times,the propo rtion of cerebrospinal fluid RPR titer which was negative is 83%,but still need lumbar puncture review;When the serum RPR titer decreased more than 8 times,the serological examination may replace the lumbar puncture reexamination,whi ch still needs further study.5.After treatment,the RPR titer of cerebrospinal fluid which become negative w as higher(75%)after half a year.No serum RPR titer was negative after six m onths.Ceftriaxone sodium and water agent penicillin were used to treat asymptom atic neurosyphilis,and there was no significant difference in the changement of RPR titer between serology and cerebrospinal fluid.For patients with penicillin all ergy can consider ceftriaxone sodium as an alternative medicine.6.There may be insufficient therapeutic dose in the treatment of early syphilis. |
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