89例麻痹性痴呆的临床分析

摘要

目的 通过分析麻痹性痴呆(general paresis of the insane,GPI)患者的临床表现、实验室检查、MRI表现,提高GPI早期诊断准确率.方法 回顾性分析2013年1月至2015年12月我院收治的89例GPI患者临床表现、实验室检查、MRI、诊断及治疗转归.结果 89例GPI患者均表现为认知损害和精神行为异常,合并言语不清18例,合并尿失禁12例,合并口唇不自主运动9例,合并癫痫6例;89例患者血清及脑脊液甲苯胺红不加热试验(TRUST)及梅毒螺旋体明胶颗粒凝集试验(TPPA)阳性,脑脊液白细胞计数增高89例,蛋白质增高85例;头部MRI弥漫性脑萎缩56例,颞叶海马萎缩52例,侧脑室周围白质病变51例,腔隙性脑梗塞16例,脑梗死3例;其中曾经误诊的患者47例,误诊52.8％;78例患者经青霉素驱梅治疗后,临床症状及脑脊液都有不同程度好转.结论 GPI临床表现多变,误诊率高,应结合实验室检查及磁共振检查综合分析,早期诊断及足疗程治疗极为重要.%Objective To analyze the clinical manifestations,laboratory results,MR image features and improve the early diagnosis of general paresis of the insane (GPI).Method Retrospectively analyzed the clinical manifestations,laboratory results,MR image features,diagnosis and treatment of 89 cases of GPI in our hospital from January 2013 to December 2015.Results The main clinical manifestations of all cases consisted of dementia and mental disorder.Serological and cerebrospinal fluid (CSF) TRUST and TPPA test were positive in all patients,CSF white cells count increased in 89 patients,and protein increased in 85 patients.Diffuse cerebral atrophy was detected in 56 cases,temporal and hippocampus regions atrophy was detected in 52 cases,white matter lesions around the lateral ventricle was detected in 51 cases,lacunar cerebral infarction was detected in 16 cases,cerebral infarction was detected in 3 cases.47 cases (52.8％) had been misdiagnosed.All patients were treated with a large dose of penicillin,and clinical symptoms in 78 cases improved.Conclusions The clinical manifestations of GPI are diverse,and easy to be misdiagnosed.The diagnosis of GPI is depended on laboratory examination and MR image.Early diagnosis and full course treatment are important.