南宁地区早期梅毒228例临床与实验分析

Analysis of clinical and laboratory of 228 cases of early syphilis in Nanning

目的总结南宁地区早期梅毒的临床特点及常用实验室诊断方法的检测效果。方法对2000年5月～2002年5月在皮肤性病与妇科门诊就诊的228例早期梅毒的临床资料进行总结分析。结果228例中 ,一期梅毒56例 (24.56% ) ,其中典型硬下疳18例 ,不典型硬下疳38例 ;二期梅毒130例(57.02% ) ,临床表现多种多样 ,其特征性皮疹掌跖暗红色斑疹出现率52.31% (68/130)、扁平湿疣出现率21.54 % (28/130);早期潜伏梅毒42例。在实验诊断方面 ,镀银染色 (Ag)、甲苯胺红不加热血清试验(TRUST)及梅毒螺旋体明胶颗粒凝集试验(TPPA)对一期梅毒敏感性分别为66.1%、83.9%、67.9% ,TRUST、TPPA对二期梅毒及早期潜伏梅毒敏感性为100%。结论二期梅毒占早期梅毒中大多数 ,掌跖暗红色斑疹、扁平湿疣是二期梅毒的重要诊断线索 ;一期梅毒因不典型硬下疳常见及实验室检查阴性率较高 ,易漏诊误诊 。

Objective To analyse clinical manifestation of early syphilis and the laboratory techniques of diagnosis. Methods 228 cases of early syphilis in STD clinic and gynecology clinic in Nanning from May,2000 to May,2002 were summarized. Results 56 of 228 cases were primary syphilis(24.6%),appearance rate of typical chancres at genital organ was 32.14%,atypical chancres 67.86%.130 of 228 were secondary syphilis(57.0%).The appearance rate of dark_red macules at palm and sole sites and condyloma flat as the clinical characteristic lesions were 52.31% and 21.54% respectively.Three laboratory techniques were evaluated in the diagnosis of those patients. Ag?TRUST as a screening method and TPPA as a confirmation test,which have been widely used at present, showed a low sensitivity (69.9%? 83.4%? 67.9% respectively) to primary syphilis.Conclusion Secondary syphilis is the major clinical type at present in Nanning. and dark_red macules at palm and sole sites and condyloma flat are important diagnosis clue to secondary syphilis.Primary syphilis may be easily lost and misdiagnosised from early diagnosis because of atypical chancres and high negtive reaction to the three laboratory techniques. [