长骨X线摄片诊断早期新生儿无症状先天性梅毒的价值

Diagnostic Value of Long Bone X-Ray Photograph on Asymptomatic Congenital Syphilis in Newborns

目的研究长骨X线摄片对早期新生儿无症状性先天梅毒的诊断价值.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在作血液梅毒抗体等各项检查同时,行长骨X线摄片检查,并总结分析其临床及X线特征.结果无症状先天性梅毒患儿26例,就诊时一般情况良好,无发热、呼吸困难、惊厥等临床表现.入院后发现,24例(92%)已有异常体征和(或)骨质破坏等改变.10例(38%)四肢长骨已存在损害.其中5例为单纯X线骨梅毒征象;骨损害的X线表现有一定特征性:主要表现为四肢长骨多发的干骺端炎、近骨端骨质对称性虫蚀状破坏.结论早期新生儿无症状先天梅毒的临床表现在就诊时不突出,但多数患儿骨骼、血象、肝脾等已存在一项或多项异常;骨损害的X线有其特征性表现,长骨放射异常可作为早期新生儿无症状先天梅毒活动的一个征象.有梅毒感染史或抗体阳性的母亲其出生的新生儿应常规行长骨X线摄片检查.

Objective To determine the incidence of long bone lesions and clinical characteristic in early newborn with asymptomatic congenital syphilis. Methods The syphilis antibody in 26 infants with asymptonmtic congenital syphilis who were diagnosed and treated in our hospital from April 2001 to May 2004 were detected, and the clinical feature and X-ray features were analyzed. Resuits Twenty-six infants and their mothers all had the antibedy positive of syphilis. Treponemal antibody titer were 4 times higher than their mothers in the infants blood serum. Their general conditions showed normal and had no symptoms when they were hospitalized. Then, there were 24 cases （92%） with positive physical signs and/or abnormal findings on the liver function tests and blood routine and long-bone radiographs, Long-bone radiographs were abnormal for approximately 38% （ 10 of 26 ）of asymptomatic newboms with congenital syphilis. Metaphysitis was shown and looked like sandwich biscuit in X-ray photograph. Conclusions Asymptonmtic congenital syphilis has no symptoms in the early stage. Bone X-ray photograph should be included in the assessment of newborns with a positive serology. Further support is needed in the diagnosis and treatment of early newborns with asymptomatic congenital syphilis.