26例早期新生儿无症状先天性梅毒

The early asymptomatic congenital syphilis in 26 newborns

目的:了解早期新生儿无症状先天性梅毒的临床特征,提高对胎传梅毒的诊治水平。方法:对我院2001年4月～2004年5月收治的26例早期新生儿无症状先天性梅毒的临床资料进行分析,并总结其临床特征。结果26例无症状先天性梅毒患儿血清梅毒螺旋体血球凝集试验(TPPA)全部阳性,滴度高于他们的母亲4倍以上,有8例患儿同时伴梅毒快速血浆反应素环状卡片试验(RPR)阳性。就诊时一般情况良好,无发热、呼吸困难、惊厥等临床症状;入院后进一步查体及辅助检查,发现仅2例(占7.7%)除血清抗体阳性外无任何阳性体征和辅助检查的异常;其余24例(占92.0%)临床上已有肝脾肿大、皮疹等异常体征和/或血象、肝功能及骨X线等改变。结论:早期新生儿无症状先天性梅毒的临床表现在就诊时不突出,而绝大多数患儿血象、骨、肝脾等已存在某一项或多项不同程度的异常;有梅毒感染史或抗体阳性的母亲其出生的新生儿必须住院观察,仔细的体检及辅助检查尽早确诊,使无症状梅毒儿及时隔离治疗,改善疾病的预后。

Objective:To study clinical characteristic of early asymptomatic congenital syphilis in newborns and improve its diagnosis and treatment.Methods:The clinical data of 26 newborns with asymptomatic congenital syphilis admitted in this hospital from April 2001 to May 2004 were analyzed to sum up its clinical characteristics.Results:26 infants with asymptomatic congenital syphilis all had the positive antibody of syphilis by treponema pallidum agglutination Assay(TPPA), their titres were higher 4 folds than their mother's, and 8 infants complicated with positive rapid plasma reagin circle card test(RPR). They had better general conditions and had not any symptoms, such as fever, dyspnea and eclampsia; there only two cases with positive serum antibody and without any positive signs and abnormal secondary examination, the other 24 cases (account for 92%) with positive sign and/or abnormal hepatic function, tetter, blood routine and long-bone X-ray examination etc.Conclusion:The newborns with early asymptomatic congenital syphilis had no prominent symptoms in the early stage of disease, the most newborns had one or more abnormity in hemogram, bone, liver and spleen; the newborns of mother with history of syphilis or positive antibody must be hospitalized to early diagnose after medical checkup and accessory examnation. The newborns with asymptomatic syphilis should be isolated to treat in time and improve their prognosis.