梅毒血清固定孕妇分娩的婴儿血清学转归

Seroconversion of serological test for syphilis in infants born to mothers with syphilis serofast reaction

目的探讨梅毒低滴度血清固定孕妇孕期治疗对分娩婴儿的血清学转归是否有影响，为临床诊治提供指导。方法34例梅毒低滴度血清固定的孕妇根据孕期是否接受治疗分为治疗组（75例）和未治疗组（59例），比较两组孕妇及分娩婴儿的梅毒甲苯胺红不需加热血清试验（TRUST）和梅毒螺旋体颗粒凝聚试验（TPPA）的变化。结果（1）两组孕妇初次TRUST滴度差异无统计学意义（x2=0．520，P=0．797）；（2）134例新生儿中有20例（14．9％）TRUST及梅毒螺旋体颗粒凝聚试验（TPPA）均为阴性，23例（17．2％）TPPA阳性，91例（67．9％）TRUST及TPPA双阳性。RUST滴度均低于或等于母亲产前的TRUST滴度，两组间差异无统计学意义（x2=0．892，P=0．607）；（3）两组中相同TRUST滴度的婴儿，TRUST转阴时间差异无统计学意义（P=0．229、0．309、1．000）；出生时TRUST滴度高者，婴儿期TRUST转阴时间晚于出生时TRUST滴度低者（均P〈0．05）；出生时TRUST阳性者，TPPA转阴时间均晚于TRUST阴性者（均P〈0．05）。TRUST1：4滴度组中未治疗的婴儿TPPA转阴时间[（14．1±1．4）个月]长于治疗组[（12．5±1．1）个月]（t=2．900，P=0．010）。结论毒低滴度血清固定的孕妇孕期治疗对新生儿TRUST及TPPA的阳性率和婴儿TRUST转阴时间无显著影响，对高TRUST滴度的婴儿TPPA转阴时间的缩短可能有一定的影响。

Objective To explore the influence of anti - syphilis treatment to pregnant women with lower titer seroresistance on infantile serum, so as to provide the guidance for clinical diagnosis and treatment. Methods Totally 134 cases of pregnant women with lower titer syphilis serofast reaction were divided into treatment group （75 cases） and untreated group （59 eases） according to whether received anti -syphilis treatment during their pregnancy. The change of syphilis serology toluidine red unheated serum test （TRUST） and Treponema pallidum particle assay （TPPA） for the two groups mothers and babies were compared. Results （ 1 ） The first detection of TRUST titers between the two groups of pregnant women did not show statistically significant difference （ X2 = 0. 520, P 〉 0.05 ）. （2） Among the 134 neonates,20 cases （14.9%） were negetive for both TRUST and TPPA,23 cases （17.2%） were Treponema pallidum particle assay （TPPA） positive only,91 cases （67.9%） were positive for both TRUST and TPPA and showed lower or equivalent TRUST titers compared to their mothers, without significant differences between the two groups（ X2 = 0. 892, P 〉 0.05 ）. （3）In the two groups of babies with the same TRUST titers, the seroreversion time of TRUST showed no significant differences （ P = 0. 229,0. 309,1. 000）. The negative time of TRUST in infants with neonatal higher titer was later than those with neonatal lower titer in the two groups （ all P 〈 0.05 ）. The infant with TRUST ± showed longer duration than those with neonatal TRUST - in TPPA seroreversion（ all P 〈0.05 ）. The seroreversion time of TPPA in infants with neonatal TRUST titer of 1：4 in untreated group was later than that in treat- ment group[ （ 14.1 ± 1.4） months vs. （ 12.5 ± 1.1 ） months, t = 2. 900, P = 0. 010 ]. Conclusion The treatment for mothers with lower titer seroresistanee in pregnant period had no influence in the positive rate of TRUST and TPPA in the neonates and seroreversion time of TRUST in infant. It may have certain effect to shorten the seroreversion time of TPPA in infant with high TRUST titer by the treatment.