2010-2014年100例咽部梅毒的临床分析

Clinical analysis of 100 patients with syphilis throat from 2010 to 2014

目的:探讨咽部梅毒的临床特点及其诊断、治疗方法,以引起临床耳鼻咽喉科医生的高度警觉,避免对该病的误诊、误治。方法:对2010年1月到2014年1月于本科室就诊的100例咽部梅毒患者进行了总结性分析。结果:100例患者中绝大多数共有的症状包括:咽部充血,扁桃体表面附有白色假膜,不易擦除,舌腭弓、咽腭弓、悬雍垂黏膜附有白色假膜,约四分之一的患者伴有颌下淋巴结肿大,大多数患者不伴有皮肤和外生殖器损害,少数患者伴有阴囊部紫红色斑疹,以及双手掌、足底脱屑性红斑,躯干皮疹。溃疡或斑疹部位主要集中在咽后壁多见。本组病例的快速血浆反应素环状片试验(RPR)6例结果为阴性,其余滴度均>1∶16,梅毒螺旋体明胶凝集试验(TPHA)检测结果均为阳性。HIV筛查结果均为阴性。共有21例患者对青霉素过敏,其中9例患者给予口服红霉素治疗,12例患者给予头孢曲松,其余患者均给予长效青霉素治疗。经过治疗,所有患者咽部症状完全消退、病损咽部黏膜恢复正常。治疗1个月后复查RPR,74例转阴,26例阳性但滴度下降。治疗3个月后复查RPR,95例均转阴。结论:以咽部黏膜病损为首发症状的梅毒患者应引起耳鼻咽喉科医生重视。咽喉部梅毒根据病史、临床特点和血清学检查均可确诊,耳鼻咽喉科医生对本病应有足够的认识,避免误诊、误治。

Objectives：To explore the clinical features and diagnosis,treatment of throat syphilis,to call the attention of clinical otorhinolaryngology doctors against the disease,in order to avoid misdiagnosis and mistreat-ment.Methods：100 cases of syphilis treated in our laboratory from January 2010 to January 2014 were summarized and analyzed.Results：The symptoms of the vast majority include：throat congestion,tonsil surface with white pseudomembrane,easy to erase,tongue palatal arch,pharyngeal arch palate,uvula mucosa with white pseudomem-brane;about one fourth had submandibular lymph nodes;the majority of patients did not have damage in the skin and genitalia;a few patients were with scrotum and double palm purple rash,scaling plantar erythema,rash torso. Ulcers or rash parts were mainly in the posterior pharyngeal wall.In the result of rapid plasma reagin circle patch test （RPR）,6 patients were negative,the rest titers 〉1：16,while the Treponema pallidum gelatin agglutination test （TPHA）results were all positive.HIV screening results were negative.21 patients were allergic to penicillin, of whom nine were treated with oral erythromycin therapy,and the remaining 12 were treated with ceftriaxone.The remaining patients were treated with long -acting penicillin therapy.After treatment,the throat symptoms of all pa-tients completely subsided,with pharyngeal mucosa lesions returned to normal.In the RPR screening a month after treatment,74 were negative and 26 cases positive but titers decreased.In the RPR screening three months after treatment,95 cases were negative.Conclusion：Otolaryngology doctors should pay more attention to patients with pharyngeal mucosa lesions of syphilis as the first symptom.Doctors can diagnose throat syphilis based on history, clinical features and serological examination.Therefore,doctors should have sufficient knowledge of the disease to avoid misdiagnosis and mistreatment.