神经梅毒的诊疗进展

doi:10.19871/j.cnki.xfcrbzz.2024.02.016

摘要/Abstract

摘要： 21世纪以来,全球范围内梅毒的发病率和患病率均在逐年升高,因梅毒的特殊传播途径使其成为严重的社会公共健康问题。与此同时,神经梅毒的发病率也随之不断升高,梅毒螺旋体对神经系统的损伤表现多种多样,感染早期更是缺乏临床特异性,如诊治不及时,将对神经系统结构和功能造成不可逆性损害,严重者甚至会失能失智。目前对神经梅毒的分类可以根据是否存在临床症状分为有症状性神经梅毒和无症状性神经梅毒;根据感染的时间分为早期神经梅毒和晚期神经梅毒,对神经梅毒的确诊主要依据脑脊液的实验室检查结果。本文着重对近年来神经梅毒的流行病学、临床表现、诊断和治疗进展等进行归纳总结,以提高临床医生对该病的诊治水平。

关键词: 梅毒, 神经梅毒, 诊断, 治疗

Abstract: Since the beginning of the 21st century, the incidence rate and prevalence of syphilis have increased year by year worldwide.Due to its unique transmission route, syphilis has become a serious social public health problem. At the same time, the incidence rate of neurosyphilis also continues to set new records. Treponema pallidum has various manifestations of damage to the nervous system, especially in the early stage of infection. If the diagnosis and treatment is not timely, it will cause irreversible damage to the structure and function of the nervous system, and even disability and dementia in serious cases.At present, neurosyphilis can be classified into symptomatic neurosyphilis and asymptomatic neurosyphilis based on the presence of clinical symptoms, or into early neurosyphilis and late neurosyphilis based on the time of infection.The diagnosis of neurosyphilis is mainly based on the results of laboratory examination of cerebrospinal fluid. This article focuses on summarizing the epidemiology, clinical manifestations, diagnosis and treatment progress of neurosyphilis in recent years, in order to improve the diagnosis and treatment skills of clinicians for this disease.

Key words: Syphilis, Neurosyphilis, Diagnosis, Treatment

中图分类号:

R514.4
R741

王启征, 赵宇, 盛琪. 神经梅毒的诊疗进展[J]. 新发传染病电子杂志, 2024, 9(2): 79-83.

Wang Qizheng, Zhao Yu, Sheng Qi. Progress in diagnosis and treatment of neurosyphilis[J]. Electronic Journal of Emerging Infectious Diseases, 2024, 9(2): 79-83.

参考文献

[1] TUDDENHAM S, GHANEM KG.Neurosyphilis: Knowledge Gaps and Controversies[J]. Sex Transm Dis, 2018, 45(3):147-151.
[2] CHOW F.Neurosyphilis[J]. Continuum (Minneap Minn), 2021, 27(4):1018-1039.
[3] 岳晓丽, 龚向东, 李婧,等. 2014—2019年中国梅毒流行趋势与特征分析[J].中华皮肤科杂志, 2021, 54(8):5.
[4] 中华人民共和国国家卫生健康委员会疾病预防控制局.2021年全国法定传染病疫情概况[J].中国病毒病杂志, 2022, 12(3):236.
[5] DE VOUX A, KIDD S, TORRONE EA.Reported Cases of Neurosyphilis Among Early Syphilis Cases-United States, 2009 to 2015[J]. Sex Transm Dis, 2018, 45(1):39-41.
[6] DU FZ, ZHANG X, ZHANG RL, et al.CARE-NS, a research strategy for neurosyphilis[J]. Front Med (Lausanne), 2023, 9:1040133.
[7] ROPPER AH.Neurosyphilis[J]. N Engl J Med, 2019, 381(14): 1358-1363.
[8] KRISHNAN D, ZAINI SS, LATIF KA, et al.Neurosyphilis presenting as acute ischemic stroke[J]. Clin Med (Lond), 2020, 20(1):95-97.
[9] ANDREAE A, BARR AC, FULTON Z, et al.Appearance of Meningovascular Neurosyphilis Causing an Acute Ischemic Stroke[J]. Sex Transm Dis, 2021, 48(8):e109-e110.
[10] GHANEM KG.Review: Neurosyphilis: A historical perspective and review[J]. CNS Neurosci Ther, 2010, 16(5):e157-e168.
[11] LACHAUD S, SUISSA L.Stroke, HIV and meningovascular syphilis: study of three cases[J]. Rev Neurol (Paris), 2010, 166(1):76-82.
[12] IMOTO W, ARIMA H, YAMADA K, et al.Incidental finding of neurosyphilis with intracranial hemorrhage and cerebral infarction: A case report[J]. J Infect Chemother, 2021, 27(3):521-525.
[13] CHARJI FE, LOUHAB N, ZAHLANE S, et al.Cerebral thrombophlebitis and neurosyphilis: Association or coincidence[J]. Rev Neurol (Paris), 2020, 176(7-8):629-631.
[14] CHOL O, GALLET S, BOUILLET L, et al.Cerebral venous thrombosis revealing neurosyphilis[J]. Rev Med Interne, 2022, 43(2):116-119.
[15] JUM'AH A, ABOUL NOUR H, ALKHOUJAH M, et al. Neurosyphilis in disguise[J]. Neuroradiology, 2022, 64(3):433-441.
[16] KODAMA K, OKADA S, KOMATSU N, et al.Relationship between MRI findings and prognosis for patients with general paresis[J]. J Neuropsychiatry Clin Neurosci, 2000, 12(2):246-250.
[17] BRIGHTBILL TC, IHMEIDAN IH, POST MJ, et al.Neurosyphilis in HIV-positive and HIV-negative patients: neuroimaging findings[J]. AJNR Am J Neuroradiol, 1995, 16(4):703-711.
[18] STEPPER F, SCHROTH G, STURZENEGGER M.Neurosyphilis mimicking Miller-Fisher syndrome: a case report and MRI findings[J]. Neurology, 1998, 51(1):269-271
[19] MCNIEL CL, BHAT N, BINDIGANAVILE SH, et al.Neurosyphilis Masquerading as Guillain-Barre Syndrome[J]. J Neuroophthalmol, 2022, 42(1):e412-e414.
[20] 叶静, 杨玉佳, 刘梅, 等. 以疼痛为唯一表现的梅毒性脊髓炎一例[J]. 华西医学, 2022, 37(9):1438-1440.
[21] PANDEY S.Magnetic resonance imaging of the spinal cord in a man with tabes dorsalis[J]. J Spinal Cord Med, 2011, 34(6):609-611.
[22] MARTIN JP.The Syphilitic Forms of Progressive Muscular Atrophy[J]. Proc R Soc Med, 1925, 18(Neurol Sect):13-20.
[23] TONG ML, LIN LR, ZHANG HL, et al.Spectrum and characterization of movement disorders secondary to neurosyphilis[J]. Parkinsonism Relat Disord, 2013, 19(4):441-445.
[24] HO KH, WRIGHT CC, UNDERBRINK MP.A rare case of laryngeal dystonia associated with neurosyphilis: Response to botulinum toxin injection[J]. Laryngoscope, 2011, 121(1): 147-149.
[25] OZBEN S, EROL C, OZER F, et al.Chorea as the presenting feature of neurosyphilis[J]. Neurol India, 2009, 57(3): 347-349.
[26] 中国疾病预防控制中心性病控制中心, 中华医学会皮肤性病学分会性病学组, 中国医师协会皮肤科医师分会性病亚专业委员会.梅毒、淋病和生殖道沙眼衣原体感染诊疗指南(2020)[J].中华皮肤科杂志,2020,53(3):169-179.
[27] KLEIN M, ANGSTWURM K, ESSER S, et al.German guidelines on the diagnosis and treatment of neurosyphilis[J]. Neurol Res Pract, 2020, 2:33.
[28] WORKOWSKI KA, BACHMANN LH, CHAN PA, et al.Sexually Transmitted Infections Treatment Guidelines, 2021[J]. MMWR Recomm Rep, 2021, 70(4):1-187.
[29] JANIER M, UNEMO M, DUPIN N, et al.2020 European guideline on the management of syphilis[J]. J Eur Acad Dermatol Venereol, 2021, 35(3):574-588.
[30] WONG T, FONSECA K, CHERNESKY MA, et al.Canadian Public Health Laboratory Network laboratory guidelines for the diagnosis of neurosyphilis in Canada[J]. Can J Infect Dis Med Microbiol, 2015, 26(Suppl A):18A-22A.
[31] TUDDENHAM S, KATZ SS, GHANEM KG.Syphilis Laboratory Guidelines: Performance Characteristics of Nontreponemal Antibody Tests[J]. Clin Infect Dis, 2020, 71(Suppl 1):S21-S42.
[32] TARGA MARTINS R, CASTILHOS RM, SILVA DA SILVA P, et al.Frequency of Screening and Prevalence of Neurosyphilis in Stroke Population[J]. Cerebrovasc Dis, 2020, 49(3):301-306.
[33] MARRA CM, TANTALO LC, MAXWELL CL, et al.The rapid plasma reagin test cannot replace the venereal disease research laboratory test for neurosyphilis diagnosis[J]. Sex Transm Dis, 2012, 39(6):453-457.
[34] ZHU L, GU X, PENG RR, et al.Comparison of the cerebrospinal fluid (CSF) toluidine red unheated serum test and the CSF rapid plasma reagin test with the CSF venereal disease research laboratory test for diagnosis of neurosyphilis among HIV-negative syphilis patients in China[J]. J Clin Microbiol, 2014, 52(3):736-740.
[35] 中华人民共和国国家卫生和计划生育委员会.WS273–2018.中华人民共和国卫生行业标准–梅毒诊断[S].北京:中国标准出版社, 2018-03-06.
[36] 孔维泽,朱以诚.神经梅毒诊断研究进展[J].中国神经免疫学和神经病学杂志, 2020, 27(3):227-230.
[37] GAO ZX, GOU Y, LIU XQ, et al.Advances in laboratory diagnostic methods for cerebrospinal fluid testing for neurosyphilis[J]. Front Public Health, 2022,10:1030480.
[38] LI D, HUANG X, SHI M, et al.Diagnostic role of CXCL13 and CSF serology in patients with neurosyphilis[J]. Sex Transm Infect, 2021, 97(7):485-489.
[39] MEHTA N, BHARI N, GUPTA S.Asian guidelines for syphilis[J]. J Infect Chemother, 2022, 28(8):1084-1091.
[40] 唐欷柯, 彭智鹏, 梁联哨,等. 艾滋病合并神经梅毒感染的最新研究进展[J/CD].新发传染病电子杂志, 2020, 5(3):203-206.