567例隐性梅毒孕妇所产新生儿的梅毒血清学检测结果及转阴情况分析

Analysis of Serological Tests for Syphilis of 567 Newborns Delivered by Pregnant Women with Latent Syphilis and Negative Conversion Situation

目的:了解隐性梅毒孕妇所产新生儿的梅毒血清学检测结果及其转归。方法:收集深圳市福田区2004～2011年妊娠隐性梅毒患者的新生儿567例,分别于出生后第1月、第3月、第6月、第9月、第12月、第18月检测其血清RPR/TPPA/19SIgM,对其结果及转阴情况进行分析,并按母亲不同RPR滴度、不同孕期接受治疗以及新生儿出生后是否接受治疗分别讨论对新生儿梅毒血清学试验转阴的影响。结果:隐性梅毒孕妇分娩的567例新生儿中,发现先天梅毒10例、梅毒血清学试验全阴性新生儿23例、仅TPPA阳性新生儿102例,RPR/TPPA双阳性新生儿432例,RPR平均转阴时间为(2.68±2.08)月、TPPA的平均转阴时间为(5.25±1.86)月;母亲RPR低滴度(≤1∶8)组与高滴度(≥1∶16)组的新生儿比较,RPR、TPPA平均转阴时间相比,差异均有统计学意义(P均<0.001)。不同孕期治疗组相比较、新生儿出生后治疗组与非治疗组比较,对疑似先天梅毒的新生儿梅毒血清学试验转阴的影响都无统计学差异。结论:隐性梅毒孕妇可致胎传梅毒,孕期及新生儿期的干预可有效防治先天梅毒的发生及发展;排除了先天梅毒的新生儿梅毒血清学试验阳性可自行转阴,与不同孕期治疗无明显相关性;母亲RPR低滴度可能是保护因素。

Objective：To study serological test for syphilis of the newborns delivered by preg- nant women with latent syphilis and the situation of negative Conversion. Methods ：567 newborns delivered by pregnant women with latent syphilis from 2004 to 2011 in Shenzhen Futian were enrolled for this retrospective study. Serological tests of RPR/TPPA/19SIgM were conducted on the newborns in 1 month, 3 months, 6 months, 9 months, 12 months and 18 months after birth, respectively. Factors such as RPR titers in mothers, stage to start treatment during pregnancy and treatment of the newborn after birth were analyzed when discussing influence on the transformation of the test results. Results ：Among the 567 cases, 10 cases suffered from congenital syphilis, 23 cases had negative results for both RPR and TPPA, 102 cases showed positive result for TPPA only, and 432 cases showed positive results for both RPR and TPPA. The average time for conversion of the newborns＇ positive results of RPR and TPPA into negative results were （2. 68±2. 08 ） months and （5.25±1.86） months for TPPA, respectively. Average time for conversion of positive results of both RPR and TPPA into negative were significantly shorter in newborns from mothers with low RPR titer （ ≤1： 8） than that with high RPR titer （ ≥1： 16） （P 〈0. 001 for both）. No statistical significance was found among different pregnancy treatment groups and the two newborn groups with or without treatment. Conclusion：Pregnancy with latent syphilis can lead to congenital syphilis, and intervention in pregnancy or newborns can prevent development of congenital syphi- lis. Positive serological tests for syphilis can automatically convert into negative results in newborns without congenital syphilis. Low RPR titer of the mothers is probably one of the protective factors, and it is not affected by treatment during pregnancy or after birth.