梅毒产妇胎盘组织病理活检诊断早期先天性梅毒的临床价值  

Clinical value of placental pathological biopsy in diagnosis of early congenital syphilis in parturient with syphilis

作　　者：赵来刚 李琴芬 王娇 李瑾 余美桦 Zhao Laigang;Li Qinfen;Wang Jiao;Li Jin;Yu Meihua(Department of Obstetrics,the Affiliated Hospital of Guizhou Medical University,Guiyang 550001,China)

机构地区：[1]贵州医科大学附属医院产科,贵阳550001

出　　处：《中国医学前沿杂志（电子版）》2020年第3期100-103,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：贵州省科技计划项目(黔科合SY字[2013]3053号)。

摘　　要：目的评价梅毒产妇胎盘组织病理活检诊断早期先天性梅毒的临床价值。方法回顾性分析2015年1月至2017年12月贵州医科大学附属医院收治的114例梅毒产妇的临床资料,按照妊娠结局分为活产无先天性梅毒组(26例)、活产有先天性梅毒组(31例)和死产有先天性梅毒组(57例),对三组产妇的胎盘组织进行病理活检,分析与先天性梅毒相关的胎盘组织病理特征。结果活产有先天性梅毒组产妇胎盘组织中出现坏死性脐带炎、绒毛增大、急性马蹄绒毛组织炎和慢性马蹄绒毛组织炎这4项病理特征的比率均显著高于活产无先天性梅毒组(均P<0.05),死产有先天性梅毒组产妇胎盘组织中出现坏死性脐带炎、绒毛增大、急性马蹄绒毛组织炎、慢性马蹄绒毛组织炎、增生性血管炎改变和成红细胞增多症这6项病理特征的比率均显著高于活产无先天性梅毒组(均P<0.05)。胎盘组织中出现绒毛增大和急性马蹄绒毛组织炎,活产伴感染早期先天性梅毒的风险分别提高7.25倍和6.14倍;胎盘组织中出现绒毛增大和成红细胞增多症,死产伴感染早期先天性梅毒的风险分别提高8.17倍和9.28倍。结论胎盘组织病理特征与先天性梅毒显著相关,病理活检作为一种无创性、易于开展的检查项目,可作为早期诊断先天性梅毒的重要辅助手段,为其监测和治疗提供理论支持和依据。Objective To evaluate the clinical value of placental pathological biopsy in the diagnosis of early congenital syphilis in parturient with syphilis.Method The clinical data of 114 parturients with syphilis admitted to the Affiliated Hospital of Guizhou Medical University from January 2015 to December 2017 were retrospectively analyzed.According to the pregnancy outcomes,they were divided into live birth without congenital syphilis group(n=26),live birth with congenital syphilis group(n=31)and stillbirth with congenital syphilis group(n=57).Pathological biopsy was performed on all placenta tissues to analyze the histological characteristics of placenta associated with congenital syphilis.Result The proportion of necrotizing funisitis,villous enlargement,acute villitis and chronic villitis in placenta tissues of live birth with congenital syphilis group were significantly higher than those of live birth without congenital syphilis group(all P<0.05),the necrotizing funisitis,villous enlargement,acute villitis,chronic villitis,fetal vasculopathy and erythroblastosis of placenta tissues in stillbirth with congenital syphilis group were significantly higher than those of live birth without congenital syphilis group(all P<0.05).Placental villi enlargement and acute villous increased the risk of congenital syphilis in early stage of live birth by 7.25 times and 6.14 times respectively.Placental villi enlargement and erythroblastosis increased the risk of congenital syphilis by 8.17 times and 9.28 times respectively in stillborn.Conclusion Placental pathological features are significantly correlated with congenital syphilis.As a non-invasive and easy-to-carry out examination item,pathological biopsy can be used as an important assistant means for early diagnosis of congenital syphilis and provide theoretical support and basis for its monitoring and treatment.

关 键 词：梅毒螺旋体 先天性梅毒 胎盘 病理活检 

分 类 号：R759.15[医药卫生—皮肤病学与性病学]