77例先天性梅毒临床特点分析

发布时间：2018-10-12 15:25

【摘要】： 目的: 研究77例先天性梅毒(congenital syphilis,CS)的临床特点。方法: 收集重庆医科大学附属儿童医院2006年2月至2009年11月住院确诊为CS 77例患儿的病例资料,分别按新生儿期与非新生儿期、有无合并其他TORCH感染分组,分析主要的临床表现、多系统损害和实验室检查方面的特点,并随访TRUST结果。结果: 1.77例CS患儿多系统损害的发生率从高到低依次是:呼吸系统、消化系统、皮肤、血液系统,消化系统中转氨酶升高以AST为主。 2.实验室检查,77例CS患儿中实验室检查异常的阳性率高低依次是:凝血象88.9%(16/18)、长骨X片76.7%(46/60)、心肌酶谱76.3%(29/38)、肾功16.4%(9/55)。 3.新生儿期与非新生儿期在皮疹、鼻阻、水肿、气促/发绀、吐奶呛奶/咳嗽、疑诊/体检、肝脾增大、贫血、颅内出血的发生率上差异有显著性(P 0.05),而在腹胀、白细胞升高、血小板减少、转氨酶升高、胆红素升高、低蛋白、胸片、尿常规异常上差异无显著性(P 0.05)。 4.77例CS患儿中37例合并其他TORCH感染,单纯CS组与合并其他TORCH感染组在肝脾增大、贫血、血小板减少、转氨酶升高、低蛋白血症及胸片有阳性发现的发生率上及转氨酶升高水平上差异有显著性(P 0.05),合并其他TORCH感染组其发生率更高,转氨酶升高更明显,但在早产、低体重、颅内出血、听力损害、先天性心脏病发生率上差异无显著性(P 0.05)。 5.77例CS中23例随访了TRUST,其中19例转阴,4例随访至6月时仅滴度下降。19例CS中1、2、3、6、12、13月时TRUST转阴率分别为26.3%(5/19)、36.8%(7/19)、57.9%(11/19)、78.9%(15/19),94.7%(18/19),100%(19/19)。结论: 1.77例CS患儿以呼吸系统、消化系统中转氨酶升高(以AST升高为主)、皮疹、血液系统中贫血、肝脾增大、低蛋白血症为主要系统损害表现。CS系全身的多系统损害性感染性疾病,其中凝血功能异常、骨损害、心肌损害发生率高,长骨X线检查可提供重要诊断依据,建议对CS患儿完善多系统相关检查. 2.CS在新生儿期表现常不典型,且与非新生儿期有差异。新生儿期以疑诊/体检就诊的无症状的CS明显高于非新生儿期,颅内出血的发生率明显高于非新生儿期,而非新生儿期的CS患儿的皮疹、鼻阻、水肿、肝脾增大、贫血发生率更高,较新生儿期更典型,因此对新生儿做CS筛查有重要意义。 3.CS易合并其他TORCH感染,合并其他TORCH感染的CS在呼吸系统、消化系统、血液系统的损害的发生率上较单纯CS组高,所引起的肝脾肿大、贫血、血小板减少、转氨酶升高、低蛋白血症及呼吸系统损害发生率显著增加,转氨酶升高更明显,肝损害程度更重,但先天性心脏病的发生率未明显上升。 4.CS患儿随访TRUST,多在6-12月内转阴。
[Abstract]:Objective: to study the clinical features of 77 cases of congenital syphilis (congenital syphilis,CS). Methods: from February 2006 to November 2009, 77 children with CS were collected from affiliated Children's Hospital of Chongqing Medical University. The main clinical manifestations, multi-system lesions and laboratory findings were analyzed and TRUST results were followed up. Results: 1.The incidence of multiple system damage in 77 cases with CS was in the order of respiratory system, digestive system, skin, blood system and digestive system. Laboratory examination showed that the positive rate of abnormal laboratory examination was 88.9% (16 / 18), 76.7% (46 / 60), 76.3% (29 / 38) and 16.4% (9 / 55), respectively. There were significant differences in the incidence of rash, nasal obstruction, edema, shortness of breath / cyanosis, dysphagia / cough, suspected diagnosis / physical examination, liver and spleen enlargement, anemia and intracranial hemorrhage (P 0.05). There was no significant difference in thrombocytopenia, transaminase, bilirubin, low protein, chest radiographs and urine routine (P0. 05). In the simple CS group and other TORCH infection groups, the liver and spleen increased, anemia, thrombocytopenia, aminotransferase increased. There were significant differences in the incidence of hypoproteinemia and the positive rate of chest radiographs and the elevated level of aminotransferase (P 0.05). In the group of other TORCH infection, the incidence was higher and the level of transaminase was higher, but in premature delivery, low body weight, intracranial hemorrhage, the incidence of transaminase was higher than that in other groups. There was no significant difference in the incidence of hearing impairment and congenital heart disease (P 0.05). In 5.77 cases of CS, 23 cases were followed up with TRUST, 19 cases turned negative, 4 cases were followed up to 6 months, only the titer decreased. In 19 cases of CS, the negative rate of TRUST was 26.3% (5/ 19), 36.8% (7 / 19), 57.9% (11 / 19), 78.9% (15 / 19), 94.7% (18 / 19), 100% (19 / 19), respectively, at the 13th month, the rate of TRUST negative was 26.3% (5 / 19), 36.8% (7 / 19), 57.9% (11 / 19), 78.9% (15 / 19), 94.7% (18 / 19), 100% (19 / 19) respectively. Conclusions: 1.Respiratory system, elevation of transaminase in digestive system (mainly increased in AST), rash, anemia in blood system, enlargement of liver and spleen were the main causes of CS. Hypoproteinemia is the main systemic lesion. CS is a systemic infectious disease with abnormal coagulation function, high incidence of bone damage and myocardial damage. X-ray examination of long bone can provide important diagnostic basis. It is suggested to improve the multisystem correlation examination for children with CS. The manifestation of 2.CS in neonatal stage is often atypical and different from that in non-neonatal stage. The incidence of intracranial hemorrhage was significantly higher in the neonates with suspected / examined CS than in the non-neonates, and the incidence of intracranial hemorrhage was significantly higher in the neonates than in the non-neonates, while the rash, nasal obstruction, edema, liver and spleen enlargement were found in the non-neonatal CS patients. The incidence of anemia is higher and more typical than the neonatal stage, so it is important to screen for CS in newborns. 3.CS is easy to combine with other TORCH infection, CS with other TORCH infection in respiratory system, digestive system, The incidence of blood system damage was higher than that of simple CS group, resulting in hepatosplenomegaly, anemia, thrombocytopenia, elevated aminotransferase, hypoproteinemia and respiratory system damage. The degree of liver damage was more serious, but the incidence of congenital heart disease did not increase significantly. TRUST, turned negative in 6 to 12 months follow-up in children with 4.CS.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2010
【分类号】：R759.1

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