52例新生儿先天性梅毒的临床特征调查及血清学指标检测分析  

Clinical characteristics of 52 cases of neonatal congenital syphilis and detection of serological indicators

作　　者：李典 张华 LI Dian;ZHANG Hua(Maternal and Childcare Centre,Beijing Youan Hospital of Capital Medical University,Beijing 100079,China)

机构地区：[1]首都医科大学附属北京佑安医院妇幼中心

出　　处：《中国性科学》2019年第12期109-113,共5页Chinese Journal of Human Sexuality

基　　金：国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治”(2017ZX10201201-001-009)

摘　　要：目的探讨新生儿先天性梅毒的临床特征及血清学指标水平。方法选取2015年1月至2018年6月首都医科大学附属北京佑安医院收治并确诊的52例先天性梅毒新生儿的病历资料作为研究对象。统计52例患儿的临床表现,比较早产及母体产前治疗对患儿临床表现的影响。应用快速血浆反应素环状卡片试验(RPR)和梅毒螺旋体明胶凝集试验(TPPA)进行血清学筛查。结果 52例先天性梅毒新生儿中,男性28例(53.85%),女性24例(46.15%)。早产儿为27例(51.92%)。临床表现发生率位列前5位的分别为贫血(55.77%)、肝功损害(53.85%)、早产(51.92%)、白细胞升高(50.00%)和皮损(46.15%)。足月儿组和早产儿组的多脏器功能损害、肝脾大、肝功损害和贫血具有显著差异(P<0.05)。母体治疗组和母体未治疗组的血尿、皮肤黄染、头MRI异常、多脏器功能损害、消化道症状、肝脾大、皮损、白细胞升高、肝功损害和贫血共10种临床表现差异具有统计学意义(P<0.05)。52例患儿的RPR及TPPA检测均为阳性, RPR滴度范围为1:4~1:512,其中RPR滴度为1:16的患儿例数最多,占总数23.08%。结论新生儿先天性梅毒的临床特征复杂多样,且无明显特异性,临床筛查中应结合血清学指标进行确诊。早产患儿的临床表现更为严重,产前母体接受治疗可有效降低新生儿的临床症状。Objective To investigate the clinical features and serum levels of neonatal congenital syphilis. Methods 52 newborns diagnosed congenital syphilis in Beijing Youan Hospital of Capital Medical University from January 2015 to June 2018 were selected. The clinical manifestations of 52 newborns were recorded and the impact of preterm and maternal antenatal treatment on the clinical manifestations was compared. Serological screening was performed using the Rapid Plasma Reactive Enzyme Loop Card Test(RPR) and the Treponema Pallid Gelatin Agglutination Test(TPPA). Results Of the 52 newborns with congenital syphilis, there were 28 male(53.85%), 24 female(46.15%) and 27 preterm infants(51.92%). The top 5 clinical manifestations were anemia(55.77%), liver function damage(53.85%), premature delivery(51.92%), white blood cell elevation(50.00%), and skin lesions(46.15%). There were statistically significant differences in multiple organ dysfunction, hepatosplenomegaly, liver function damage, and anemia between the term infant group and the preterm infant group(P<0.05). The differences in the following 10 clinical manifestations including hematuria, xanthochromia, abnormal MRI, multiple organ dysfunction, gastrointestinal symptoms, hepatosplenomegaly, skin lesions, elevated white blood cells, liver function damage and anemia between the two groups were statistically significant(P < 0.05). The RPR and TPPA tests were positive in all 52 newborns. The RPR titer ranged from 1:4 to 1:512, where the number of newborns with RPR titer of 1:16 was the highest, accounting for 23.08%. Conclusions The clinical features of congenital syphilis in neonates are complex and diverse without obvious specificity, so serological indicators should be used in clinical screening for diagnosis. The clinical manifestations of preterm children are severe, and prenatal maternal treatment can effectively reduce the clinical symptoms of newborns.

关 键 词：新生儿 先天性梅毒 血清学指标 早产 母体治疗 临床表现 

分 类 号：R759[医药卫生—皮肤病学与性病学]