先天性梅毒致新生儿多器官功能损害3例临床特征分析  

Clinical Analysis of Three Cases of Neonatal Multiple Organ Dysfunction Caused by Congenital Syphilis

作　　者：朱晶文 张雪峰[1] ZHU Jingwen;ZHANG Xuefeng(Department of Pediatrics,PLA General Hospital,Pediatric Department of the Fifth Medical Center of PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院儿科学部,解放军总医院第五医学中心儿科,北京100039

出　　处：《中国皮肤性病学杂志》2022年第6期690-694,704,共6页The Chinese Journal of Dermatovenereology

摘　　要：目的归纳、分析3例新生儿期先天性梅毒致多器官功能损害病例的临床特点及治疗经验。方法回顾性分析2012年1月-2021年6月解放军总医院第五医学中心儿科收治的3例新生儿期先天性梅毒致多器官功能损害患儿的临床特征、诊断、治疗及预后。结果3例患儿均为新生儿期内发病,母亲均为梅毒患者,孕期未进行规范驱梅治疗或未治疗。3例患儿分别以呼吸困难、发热、皮肤破溃为首发症状就诊,入院后均确诊先天性梅毒。3例患程中均出现肝大、肝酶升高、血清总胆红素及直接胆红素升高,诊断婴儿胆汁淤积性肝炎;3例患儿病程中均逐步出现蛋白尿、低白蛋白血症,伴有胆固醇、甘油三酯升高,诊断肾病综合征;3例患儿均有不同程度贫血,1例患儿合并凝血功能异常;2例患儿合并皮肤脱屑、破溃;1例患儿行X线检测提示骨损害。入院后3例患儿均给予足量、长疗程(3周)青霉素驱梅治疗,以及相应对症治疗,先天性梅毒导致的肾病综合征未予激素治疗。治疗后患儿快速血浆反应素试验滴度均下降,3例患儿出院时皮肤损害均痊愈,肾病综合征、贫血明显好转,但3例患儿肝功能异常情况较前无明显好转。结论新生儿期先天性梅毒患儿发生多器官功能损害较为少见。在经过足量、长疗程驱梅治疗以及相应的对症治疗后,继发的泌尿系统、血液系统、皮肤损害均预后良好,肝损害短期治疗效果欠佳,恢复慢,需长期随诊治疗。Objective To summarize and analyze the clinical characteristics and treatment experience of three cases of multiple organ dysfunction syndrome caused by congenital syphilis in the neonatal period.Methods The clinical features,diagnosis,treatment and prognosis were retrospectively analyzed in the three children with multiple organ function impairment caused by congenital syphilis during neonatal period admitted to pediatric department.Results The onset of the three cases was in the neonatal period,and all their mothers were all syphilis patients who did not receive standard treatment or no treatment during pregnancy.Dyspnea,fever and skin ulceration were the first symptoms in three cases,and all of them were diagnosed as congenital syphilis after admission.All the three cases were diagnosed as infantile cholestatic hepatitis due to hepatomegaly,elevated liver enzymes,elevated serum total bilirubin and direct bilirubin.They all developed hypoalbuminemia proteinuria and elevated cholesterol and triglyceride,thereby being diagnosed as nephrotic syndrome.All of them had different degrees of anemia.Coagulation dysfunction was found in one case,skin desquamation and ulceration were found in two cases,and X-ray examination showed bone damage in one case.After admission,all the three patients were given sufficient penicillin for a long course of treatment(three weeks)and corresponding symptomatics treatment.Nephrotic syndrome due to congenital syphilis was not treated with corticosteroid therapy.After treatment,the titer of rapid plasma regain decreased in all patients.The skin lesions of three children were cured when they were discharged from hospital,and the nephrotic syndrome and anemia were obviously improved.However,there was no significant improvement in the liver function in three cases.Conclusion Multiple organ dysfunction is rare in neonates with congenital syphilis.The prognosis of secondary urinary system,hematological system and skin lesions was good after adequate and long-term anti-syphilis treatment and co

关 键 词：梅毒 先天性 婴儿 新生 肾病综合征 婴儿胆汁淤积性肝炎 贫血 

分 类 号：R759.1[医药卫生—皮肤病学与性病学]