先天性梅毒高危因素及临床特征分析

发布时间：2018-05-13 20:12

本文选题：先天性梅毒 + 产前保健　；参考：《复旦大学》2012年硕士论文

【摘要】：目的通过回顾分析1999年至2009年复旦大学附属儿科医院收治的先天性梅毒高危儿的病历资料,以了解收治的先天性梅毒高危儿的评估、分类情况,探讨先天性梅毒相关的母亲特征,分析先天性梅毒临床特征及先天性梅毒高危儿治疗情况。方法本研究回顾了1999年-2009年复旦大学附属儿科医院收治的先天性梅毒高危儿病历资料,收集的信息包括母亲特征(年龄、职业、户籍、流产史、梅毒产前诊治特征)、患儿一般特征、患儿临床评估结果。本研究参照美国疾病预防控制中心(CDC)先天性梅毒监测定义,结合母亲产前梅毒诊治情况及患儿临床评估结果将先天性梅毒高危儿分为先天性梅毒病例和其他先天性梅毒高危儿,其中具有临床异常特征(包括特征性皮疹、肝脾肿大、长骨片异常、或19S-lgM阳性)的病例称为临床先天性梅毒病例；比较临床先天性梅毒病例和其他患儿(包括其他先天性梅毒病例及其他先天性梅毒高危儿)母亲相关特征；比较产前正规治疗和非正规治疗母亲相关特征：描述临床先天性梅毒病例及19S-lgM阳性先天性梅毒病例临床特征；分析先天性梅毒高危儿青霉素治疗时间、住院费用及出院前RPR转归。结果(1)先天性梅毒高危儿评估、分类情况：1999年至2009年间共收治1670例先天性梅毒高危儿。先天性梅毒高危儿数量逐年迅速增加,从1999年10例、2004年的92例、直至2009年的368例。58.3%(973/1670)患儿生后1天内入院,3.9%(65/1670)入院时年龄大于28天。早产比率为12.6%(208/1650)、低出生体重比率为10.6%(177/1637),剖宫产比率为55.8%(932/1670)。仅30.2%(503/1670)患儿母亲为孕前或者孕早期筛查发现梅毒；大于产前4周使用青霉素治疗的比例为25.8%(43]/1670),未治疗比例为31.8%(531/1670)。先天性梅毒高危儿体格检查异常(包括特征性皮疹或者肝脾肿大)比例为13.5%(225/1670),血清19S-lgM阳性率为11%(157/1422),长骨片异常率为13.2%(208/1578)。1670例先天性梅毒高危儿参照美国CDC先天性梅毒监测定义,分为先天性梅毒病例1319例(包括临床先天性梅毒病例407例),其他先天性梅毒高危儿351例。(2)先天性梅毒相关母亲特征：1598例上海市出生先天性梅毒高危儿纳入本分析,其中临床先天性梅毒病例383例,其他患儿1215例(包括其他先天性梅毒病例869例及其他先天性梅毒高危儿346例)。通过单因素比较发现,母亲年龄小、经济状况相对劣势、初产、梅毒筛查时间晚、未接受治疗、母亲RPR滴度≥1：8、母亲19S-lgM阳性与临床先天性梅毒的发生明显相关。通过比较424例接受正规治疗的母亲和1174例未接受正规治疗的母亲相关特征,发现非本地户籍与母亲非正规治疗(未接受治疗、治疗起始时间小于产前4周、治疗情况不详、非青霉素治疗)明显相关。(3)临床先天性梅毒病例临床特征：407例临床先天性梅毒病例中,新生儿病例363例,新生儿期后病例44例。和新生儿临床先天性梅毒病例相比,新生儿期后临床先天性梅毒病例临床异常特征比例更高,包括肝肿大(65.1%vs.25.1%,p0.001),脾肿大(39.5%vs.15.8%, p=0.001), RPR滴度≥1:8(59.1%vs.39.7%, p=0.014),19S-lgM阳性(67.7%vs.42.3%,p=0.005),贫血(72.7%vs.19.0%, p0.001), CRP升高(53.1%vs.26.9%,p=0.002)。和足月新生儿临床先天性梅毒病例相比,早产新生儿先天性梅毒病例临床异常特征更多：肝肿大(40.2%vs18.4%,p0.001),脾肿大(28.9%vs.10%, p0.001), RPR滴度≥1:8(70.8%vs.27.7%, p0.001),19S-lgM阳性(70.4%vs.31.6%,p0.001),贫血(29.9%vs.14%,p=0.001),血小板减少(38.1%vs.8.9%, p0.001), CRP升高(51.7%vs.16.7%,p0.001),长骨片异常(60.2%vs.46.6%, p=0.025)。(4)19S-IgM阳性病例临床特征分析：130例19S-lgM阳性新生儿先天性梅毒病例中包括72例足月病例及58例早产病例。和足月19S-lgM阳性病例相比,早产19S-lgM阳性病例临床异常特征更多：特征性皮疹(36.2%vs.9.7%,p0.001),肝肿大(51.7%vs.25%,p=0.02),脾肿大(32.8%vs.15.4%, p=0.02), RPR滴度≥1：8(96.6%vs.70.8%,p0.001),血小板减少(43.1%vs.23.6%, p=0.018), CRP升高(65.5%vs.36.5%,p=0.002),长骨片异常(46.4%vs.20.9%,p=0.003)。早产19S-lgM阳性病例母亲未接受产前梅毒诊治的比例高(40.3%vs.15.5%,p=0.003)。早立19S-lgM阳性病例放弃治疗比例较足月儿高(31%vs.12.9%,p=0.012)。(5)先天性梅毒高危儿治疗和出院随访时RPR转归：64.1%(1045/1670)患儿接受10-14天青霉素治疗,2009年共收治368例先天性梅毒高危儿,临床先天性梅毒病例平均住院费用为7087元,其他先天性梅毒病例平均住院费用为4773元,其他先天性梅毒高危儿平均住院费用为4218元。1670例先天性梅毒高危儿中入院后共有388人进行RPR复查,其中临床先天性梅毒病例28.4%(110/388),19S-lgM阳性病例比例为19.9%(61/307)；入院7天至30天复查比例为84.8%(329/388),入院时RPR阴性患儿中10.4%(23/221)患儿出现RPR转为阳性,RPR1：8的患儿58.6%(58/99)转为阴性,RPR≥1：8患儿45.6%(31/68)患儿转为RPR1：8或者阴性。结论(1)1999-2009年先天性梅毒高危儿收治人数迅速上升,产前梅毒诊治仍需加强；但是临床先天性梅毒病例未出现相似的快速增长,提示孕期梅毒筛查制度在预防先天性梅毒的发生中发挥了重要作用。(2)先天性梅毒的发生与母亲相对劣势的社会经济学状况、不恰当的母亲梅毒产前诊治(筛查时间晚、或者不治疗)及母亲梅毒处于活动期明显相关。(3)新生儿期后住院临床先天性梅毒病例临床异常特征较新生儿期住院病例多,早产新生儿临床先天性梅毒病例临床异常特征较足月新生儿多,提示先天性梅毒的临床表现多样,先天性梅毒的临床诊断仍存在困难,包括血清学诊断,骨梅毒诊断,神经梅毒诊断等。(4)早产19S-IgM阳性先天性梅毒病例受累严重程度较足月病例重。(5)先天性梅毒的评估、诊断、治疗、预防仍需要加强规范；尚需加强新生儿科、产科、卫生管理等多部门之间临床信息的共享。
[Abstract]:Objective through a retrospective analysis of the medical records of congenital syphilis in the Paediatrics Hospital Affiliated to Fudan University from 1999 to 2009, in order to understand the evaluation and classification of congenital syphilis, the characteristics of congenital syphilis related mothers were discussed, the clinical characteristics of congenital syphilis and the treatment of congenital syphilis high risk infants were analyzed. Condition.
Methods this study reviewed the medical records of congenital syphilis in the Paediatrics Hospital Affiliated to Fudan University in 1999 -2009, and collected information including the characteristics of mother (age, occupation, household registration, abortion history, the characteristics of prenatal diagnosis and treatment of syphilis), the general characteristics of the children and the clinical evaluation results of the children. The study referred to the center for disease prevention and control of the United States (CDC The definition of congenital syphilis monitoring, combined with the diagnosis and treatment of prenatal syphilis and the clinical evaluation of the children, divided the congenital syphilis high-risk infants into congenital syphilis cases and other congenital syphilis high risk infants, which have clinical abnormal characteristics (including characteristic rash, hepatomegaly, long bone abnormality, or 19S-lgM positive) cases known as the face of the disease. Cases of congenital syphilis in bed; comparison of the related characteristics of clinical congenital syphilis cases and other children (including other congenital syphilis cases and other congenital syphilis high risk children); compare the related characteristics of the normal prenatal treatment and the irregular treatment of the mother: describe the clinical congenital malx cases and the 19S-lgM positive congenital syphilis cases The clinical characteristics of children with congenital syphilis were analyzed. The penicillin treatment time, hospitalization expenses and RPR outcome before discharge were analyzed.
Results (1) assessment of congenital syphilis high-risk infants, classification: from 1999 to 2009, 1670 cases of congenital syphilis high risk infants were treated. The number of congenital syphilis high-risk infants increased rapidly year by year, from 10 cases in 1999, 92 in 2004, 368 cases of.58.3% (973/1670) in 2009 and 1 days after birth, and 3.9% (65/1670) more than 28 at admission. The rate of preterm birth was 12.6% (208/1650), the rate of low birth weight was 10.6% (177/1637) and the cesarean section rate was 55.8% (932/1670). Only 30.2% (503/1670) mothers were screened for syphilis before or in early pregnancy; the ratio of penicillin for the 4 weeks prior to birth was 25.8% (43]/1670), and 31.8% (531/1670) was untreated. Congenital syphilis The proportion of abnormal physical examination (including characteristic rash or hepatomegaly) was 13.5% (225/1670), the positive rate of serum 19S-lgM was 11% (157/1422), the abnormal rate of long bone was 13.2% (208/1578), and the high risk infants in.1670 cases of congenital syphilis were divided into 1319 cases of congenital syphilis (including congenital congenital syphilis, including congenital congenital syphilis). 407 cases of syphilis cases, 351 cases of other congenital syphilis high risk children. (2) congenital syphilis related mother characteristics: 1598 cases of congenital syphilis high-risk infants born in Shanghai were included in this analysis, including 383 cases of congenital syphilis and 1215 cases of other children (including 869 cases of other congenital syphilis and 346 cases of other congenital syphilis cases). Through single factor comparison, it was found that mother's age is small, economic situation is relatively inferior, primary birth, screening time of syphilis late, untreated, mother's RPR titer more than 1:8, mother 19S-lgM positive and clinical congenital syphilis. By comparing 424 mothers with regular treatment and 1174 mothers who have not received regular treatment. The clinical features of non local domicile and mother's irregular treatment (untreated, initial time less than 4 weeks prior to birth, unknown treatment, non penicillin) were significantly related. (3) clinical features of congenital syphilis cases: 407 cases of congenital syphilis, 363 newborns, 44 postneonatal cases. Compared with congenital syphilis cases, the clinical abnormal characteristics of congenital syphilis cases were higher in newborns, including 65.1%vs.25.1% (p0.001), splenomegaly (39.5%vs.15.8%, p=0.001), RPR titer more than 1:8 (59.1%vs.39.7%, p=0.014), 19S-lgM Yang (67.7%vs.42.3%, p=0.005), anemia (72.7%vs.19.0%,), increased (53.1 %vs.26.9%, p=0.002). Compared with the clinical congenital syphilis cases in full-term newborns, the clinical abnormal characteristics of congenital syphilis in premature newborns are more characterized by hepatomegaly (40.2%vs18.4%, p0.001), splenomegaly (28.9%vs.10%, p0.001), RPR titer more than 1:8 (70.8%vs.27.7%, p0.001), 19S-lgM positive (70.4%vs.31.6%, p0.001), anemia, and anemia. Thrombocytopenia (38.1%vs.8.9%, p0.001), CRP elevation (51.7%vs.16.7%, p0.001), long bone fragment anomaly (60.2%vs.46.6%, p=0.025). (4) analysis of the clinical characteristics of 19S-IgM positive cases: 130 cases of congenital syphilis of 19S-lgM positive neonates include 72 cases of full term disease and 58 cases of premature delivery. Compared with full term 19S-lgM positive cases, the premature birth is 19S-lgM. The clinical abnormal characteristics of the positive cases were more: 36.2%vs.9.7% (p0.001), hepatomegaly (51.7%vs.25%, p=0.02), splenomegaly (32.8%vs.15.4%, p=0.02), RPR titer more than 1:8 (96.6%vs.70.8%, p0.001), thrombocytopenia (43.1%vs.23.6%, p=0.018), abnormal long bones, preterm birth. 19S-lgM positive cases mothers did not receive prenatal diagnosis and treatment of syphilis (40.3%vs.15.5%, p=0.003). The rate of abandonment of early 19S-lgM positive cases was higher than that of full moon (31%vs.12.9%, p=0.012). (5) the treatment of congenital syphilis high-risk infants and the follow-up of the discharge of RPR: 64.1% (1045/1670) children received 10-14 days penicillin treatment, in 2009, a total of patients were treated. 368 cases of congenital syphilis high risk infants, the average hospitalization cost of clinical congenital syphilis was 7087 yuan, the average hospitalization expenses of other congenital syphilis cases were 4773 yuan, the average hospitalization expenses of other congenital syphilis infants were 4218 yuan.1670 cases, and 388 patients were reexamined after admission to the high risk children of congenital syphilis, including clinical congenital plum. The proportion of 19S-lgM positive cases was 28.4% (110/388), and the proportion of 19S-lgM positive cases was 84.8% (61/307); 10.4% (23/221) of children with RPR negative children were turned positive at admission, 58.6% (58/99) to negative in RPR1:8, and 45.6% (31/68) children in RPR > 1:8 children.
Conclusion (1) the number of patients with congenital syphilis at high risk increased rapidly in 1999-2009 years, and the diagnosis and treatment of prenatal syphilis still needs to be strengthened. However, there is no similar rapid growth in the clinical congenital syphilis cases. It suggests that the screening system of syphilis plays a important role in preventing the occurrence of congenital syphilis. (2) congenital syphilis is relative to the mother. The status of inferior social economics, inappropriate prenatal diagnosis and treatment of syphilis (late screening time, or non treatment) and mother syphilis in the active period were significantly related. (3) the clinical abnormal characteristics of congenital syphilis cases in hospitalized neonates were more than those in newborns, and the clinical abnormality of clinical congenital syphilis cases in premature newborn infants The clinical manifestations of congenital syphilis are diverse and the clinical manifestations of congenital syphilis are varied. The clinical diagnosis of congenital syphilis is still difficult, including serological diagnosis, diagnosis of bone syphilis, diagnosis of neurosyphilis. (4) the seriousness of premature 19S-IgM positive congenital syphilis cases is more serious than that of full term cases. (5) assessment, diagnosis and treatment of congenital syphilis. Prevention still needs to be strengthened, and the sharing of clinical information between departments of Pediatrics, obstetrics, and health management is needed.

【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R759.1

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