新生儿先天性梅毒临床特点及再发危险因素分析

Clinical features of neonatal congenital syphilis and associated high risk factor for recurrence

目的探讨新生儿先天性梅毒的临床特点及再发梅毒的危险因素。方法选择2005—2008年本院新生儿重症监护室收治的新生儿先天性梅毒患儿,回顾性分析其临床资料。患儿出院18个月后行问卷调查,根据是否再感染或复发梅毒分为再发组和无再发组,并对问卷结果进行单因素分析和Logistic回归分析。结果先天性梅毒65例,缺乏特异性临床表现,45例(69.2%)来自低文化教育家庭。共有54例完成问卷,其中无再发组45例,再发组9例。单因素分析显示,再发组患儿父母中接受健康教育、积极接受梅毒血清学检查、注意患儿衣物清洗和消毒比例均低于无再发组(分别为22.2%比64.4%、33.3%比75.6%、55.6%比88.9%,P均<0.05),而父母梅毒血清学RPR持续阳性的比例高于无再发组(77.8%比13.3%,P<0.05);Logistic回归分析提示,患儿父母RPR持续阳性是患儿再发梅毒的高危因素(OR=51.170,P=0.002),对患儿父母进行健康教育是患儿再发梅毒的保护因素(OR=0.057,P=0.025)。结论目前先天性梅毒患儿主要来源于低文化教育水平家庭,缺乏特异性临床表现,经正规治疗后,仍可能再发,通过进行梅毒相关的健康教育,可减少患儿再发梅毒的机会。

Objective The aim of this study was to analyze the clinical features of neonatal congenital syphilis and the associated high risk factor for recurrence. Methods Retrospectively analyzed the clinical data of the newborn infants admitted into NICU of the Yuying Children Hospital of Wenzhou Medical College between 2005 to 2008 with a confirmed diagnosis of congenital syphilis. 18 months after those infants were discharged,questionnaires were sent to those infants＇ parents. They were further divided into two groups：non-recurrence,recurrence group,depending on their syphilis status. The questionnaires were analysed by univariate comparison and Logistic analysis. Results There were a total of sixty five confirmed cases of neonatal congenital syphilis during the study period. The clinical manifestations were non-specific. Forty-five cases （69.2%） come from poor education families. Fifty-four cases received questionnaire. Forty-five cases in non-recurrence group and the other 9 cases in recurrence group. Univariate comparison showed that syphilis recurrence is higher with lower level of health-education,compliance in syphilis testing,and cleaning and disinfecting the infants＇ clothing,when recurrence group compared with non-recurrence group （respectively 22.2% vs 64.4%,33.3% vs 75.6%,55.6% vs 88.9%,and P〈0.05）. The rate of persistent RPR positive rate in parent is associated with higher rate of infants＇ recurrence rate in recurrence group and non recurrence group （77.8% vs 13.3%,and P 0.05）. Logistic analysis demonstrated that RPR persistent positive rate was associated with infants＇ syphilis recurrence （OR=51.17,P=0.002）,and providing health-education to those parents would give a protective function （OR=0.057,P=0.025）. Conclusions Neonatal congenital syphilis cases mostly come from the poor education family. They showed little specific clinical manifestation. Despite proper treatment given,those infants still have possibility of recurrence. Though improving heath-education to their parents can lower the risk of infants＇ syphilis recurrenc