van Eijk R V, Wolters E C, Tutuarima J A, Hische E A, Bos J D, van Trotsenburg L, de Koning G A, van der Helm H J
Genitourin Med. 1987 Apr;63(2):77-82. doi: 10.1136/sti.63.2.77.
Neurological examination and investigation of the cerebrospinal fluid (CSF) was performed on 24 patients with early and 180 patients with late syphilis. In 21 (12%) patients with late syphilis positive CSF treponemal test results and neurological deficits suggestive of symptomatic neurosyphilis were found. Concomitantly all but three patients with neurosyphilis showed one or more of the following abnormal CSF variables: CSF concentration of albumin X 10(3)/serum concentration (albumin ratio) greater than or equal to 7.9; mononuclear cells greater than 5 microliters: ratio of CSF to serum IgG concentrations/ratio of CSF to serum albumin concentrations (IgG index) greater than or equal to 0.7 or of IgM/albumin (IgM index) greater than or equal to 0.1; or oligoclonal CSF immunoglobulins. In 20 (95%) patients with neurosyphilis evidence of the production of treponemal antibodies within the central nervous system (CNS) was shown. Ten (48%) patients with neurosyphilis had been treated previously for late syphilis. These observations emphasise the need to screen for neurosyphilis in patients with late syphilis. Intrathecal production of treponemal antibodies was detected in six (25%) patients with early and 44 (28%) with late syphilis who did not show any neurological deficit. Intrathecal production of treponemal antibodies indicating that the CNS was affected led us to suspect asymptomatic neurosyphilis in these patients. Seventeen (11%) patients with late syphilis but no neurosyphilis and only one (4%) with early syphilis showed additional abnormal CSF variables. Surprisingly, six out of 22 patients with treated early and 20 out of 68 patients with treated late syphilis showed evidence of treponema antibody production within the CNS. We do not know whether these findings indicate that the CNS was affected because of inadequate treatment or merely reflect persistent synthesis of treponemal antibodies associated with cured infection. In one (4%) patient with early and in 21 (13%) with late syphilis but no neurosyphilis abnormal CSF variables in the absence of positive CSF treponemal test results were observed, which excluded syphilitic inflammation of the CNS.
对24例早期梅毒患者和180例晚期梅毒患者进行了神经系统检查及脑脊液（CSF）检测。在180例晚期梅毒患者中，有21例（12%）脑脊液梅毒螺旋体检测结果呈阳性，且存在提示有症状性神经梅毒的神经功能缺损。同时，除3例神经梅毒患者外，所有患者均表现出以下一种或多种脑脊液异常指标：脑脊液白蛋白浓度×10³/血清浓度（白蛋白比率）大于或等于7.9；单核细胞大于5微升；脑脊液与血清IgG浓度之比/脑脊液与血清白蛋白浓度之比（IgG指数）大于或等于0.7或IgM/白蛋白（IgM指数）大于或等于0.1；或脑脊液寡克隆免疫球蛋白。在20例（95%）神经梅毒患者中，显示有中枢神经系统（CNS）内梅毒螺旋体抗体产生的证据。10例（48%）神经梅毒患者既往曾接受过晚期梅毒治疗。这些观察结果强调了对晚期梅毒患者进行神经梅毒筛查的必要性。在6例（25%）早期梅毒患者和44例（28%）晚期梅毒患者中检测到鞘内梅毒螺旋体抗体产生，这些患者均未表现出任何神经功能缺损。鞘内梅毒螺旋体抗体产生表明中枢神经系统受到影响，这使我们怀疑这些患者患有无症状神经梅毒。17例（11%）晚期梅毒但无神经梅毒的患者以及仅1例（4%）早期梅毒患者表现出额外的脑脊液异常指标。令人惊讶的是，22例接受治疗的早期梅毒患者中有6例以及68例接受治疗的晚期梅毒患者中有20例显示有中枢神经系统内梅毒螺旋体抗体产生的证据。我们不知道这些发现是表明中枢神经系统因治疗不充分而受到影响，还是仅仅反映了与已治愈感染相关的梅毒螺旋体抗体的持续合成。在1例（4%）早期梅毒患者和21例（13%）晚期梅毒但无神经梅毒的患者中，在脑脊液梅毒螺旋体检测结果为阴性的情况下观察到脑脊液异常指标，这排除了中枢神经系统的梅毒炎症。
