新生儿先天性梅毒预防及早期诊断探讨

Prevention and early diagnosis of neonatal congenital syphilis

目的探讨母亲梅毒治疗情况对新生儿先天性梅毒发病的影响。方法回顾性分析2007年1月至2010年6月我科梅毒螺旋体明胶颗粒凝集试验(TPPA)阳性新生儿的临床资料。将TPPA阳性新生儿分成母亲正规治疗组、非正规治疗组及未治疗组,对3组新生儿先天性梅毒发病情况进行统计学分析,总结新生儿先天性梅毒的临床表现。结果 117例TPPA阳性新生儿中,确诊先天性梅毒患儿26例。母亲正规治疗组新生儿先天性梅毒发生率明显低于非正规治疗组及未治疗组(6.6%比47.1%、36.1%,P均<0.01)。新生儿先天性梅毒可累及多个系统,表现为皮肤损害、病理性黄疸、肝脾肿大、水肿、贫血、血小板减少、C反应蛋白增高、骨损害、脑脊液异常等。结论新生儿先天性梅毒临床表现缺乏特异性,早期诊断需结合母亲病史及梅毒血清学检查。积极防治母亲梅毒感染是预防新生儿先天性梅毒的关键。

Objective To study investigate the effectiveness on treatment on the incidence of congenital syphilis （CS） , and the early diagnosis of congenital syphilis in newborn babies. Methods The clinical data of TPPA positive neonates in our department from Janual？i 2007 to June 2010 were analyzed retrospectively. The TPPA positive neonates were allocated into three groups： the first group whose mothers received regular threatment, the second whose mothers received irregular threatment, and the third whose mothers didn＇t receive any threatment. The incidence of neonatal congenital syphilis in the three groups were subjected to statistical analysis. The clinical characters of neonatal congenital syphilis were summarized. Results 26 cases of congenital syphilis were diagnosed out of 117 cases of TPPA positive neonates. The incidence of neonatal congenital syphilis in first group whose mothers received regular threatment was significantly lower than it in the other two. （6.6% to 47. 1% ,36.1% ,P 〈0.01 ）. The clinical characters of neonatal congenital syphilis involved multi-system signs, such as mucocutaneous lesions, pathological jaundice, hepatosplenomegaly, edema, anemia, thrombocytopenia, etc. Conclusion The prevention and treatment of syphilis infection in the mothers are key points to prevention of congenital syphilis. The clinical characters of neonatal congenital syphilis lacked specificity. Mother＇s history and syphilis serology were important to the early diagnosis.