先天梅毒患儿的血清学随访  

Follow-up study on the serological reactivity of infants diagnosed with congenital syphilis in Shanghai

作　　者：顾伟鸣[1] 赵根明[2] 杨阳[1] 徐丽玲[2] 胡伟忠[1] 吴磊[1] 袁雪玲[1] 王学民[1] 

机构地区：[1]上海市皮肤病性病医院,200050 [2]复旦大学公共卫生学院流行病学教研室

出　　处：《中华传染病杂志》2007年第2期117-119,共3页Chinese Journal of Infectious Diseases

基　　金：上海市自然基金(02ZB14084)

摘　　要：目的了解先天梅毒患儿的假阳性情况,分析误诊的可能原因。方法收集近5年上海市部分医疗机构临床诊断的先天梅毒患儿的基本信息,对新生儿血清学追踪至梅毒快速血浆反应(RPR)和梅毒螺旋体明胶凝集试验(TPPA)呈阴性,或24月龄。同时对部分患儿的母亲进行病史资料收集和血清学抗体的监测。结果收集临床诊断先天性梅毒患儿99例,仅31.3%(31/99)有临床症状或疑似症状,诊断先天梅毒的主要依据为常规梅毒抗体检测阳性。先天梅毒患儿在出生1～3、3～6、6～12、12～18、18～24月龄的RPR和TPPA累计阴转率分别为44.2%、64.0%、72.7%、83.9%、87.1%和1.1%、18.6%、44.6%、66.7%、74.4%,而梅毒母亲的TPPA反应始终呈阳性。结论仅依据RPR和TPPA的阳性结果诊断先天梅毒,缺乏充分证据。充分发挥专业队伍的作用,可提高先天梅毒诊断的准确性。Objective To determine the status of false-positive report of congenital syphilis （CS）, to analyze the possible causes of mis-diagnosis. Methods Basic information on CS in Shanghai in the past five years was collected. We identified infants diagnosed with CS and followed up the serological reactivity of those patients and their mothers. The serological reactivity[rapid plasmin reagin （RPR） and treponema palidum hemagglutination assay（TPPA）] of infants was followed-up for up to 24 months, or until both antibodies turned to negative. The medical history of the mothers was collected, and their sera were examined for syphilitic antibodies. Results Total 99 infants diagnosed with CS were recruited. The major diagnostic method was treponemal antibody detection. Only 31.3% of the 99 infants exhibited clinical symptoms or syphilis-like symptoms at delivery. The cumulative RPR loss rates of the infants were 44. 2%, 64.0%, 72.7%, 83.9% and 87.1% at 1-3, 3-6, 6- 12, 12-18 and 18-24 months after birth, respectively. The cumulative TPPA loss rates were 1.1%, 18. 6%, 44. 6%, 66.7% and 74. 4% for 1-3, 3-6, 6-12, 12-18 and 18-24 months after birth, respectively. TPPA remained positive in all mothers with syphilis. Conclusion The diagnosis of congenital syphilis determined solely by the positive tests of RPR and TPPA is unreliable and can be misdiagnosis. The diagnosis and management of congenital syphilis should be urgently improved, and that the professional health institutions should perform and closely monitor the quality controls in the diagnosis of CS and standardize the intervention strategy of maternal syphilis.

关 键 词：梅毒 先天性 梅毒血清诊断 随访研究 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]