母梅毒之新生儿13例临床分析

对母确诊为梅毒的13例新生儿病例进行临床分型、影像学检查、免疫测定和定期随访,探讨母产前梅毒螺旋体治疗情况对新生儿发病的影响,新生儿期先天性梅毒(CS)的主要临床表现。新生儿期确诊为CS共5例,疑诊3例,正常5例;确诊5例中母未治疗4例,产时较治疗前RPR滴度下降<4倍1例,产时RPR滴度>1:4共4例,新生儿RPR滴度≥母4倍3例。CS临床表现以早产、肝脾肿大、皮疹为主。神经系统早期改变主要为脑脊液蛋白增高。13例中失防2例,确诊组和正常组各1例;确诊组1例给予重复治疗,3例RPR滴度不同程度下降;疑诊组RPR滴度均在4个月内阴转;正常组持续阴性。结论:新生儿期的CS症状不典型,需根据临床、X线检查以及血清学等综合分析进行诊断。母产前定期监测、有效治疗可降低CS的发病率,而新生儿科医师对该病的认识和警惕性有利于患儿得到及时治疗。

CLINICAL STUDY OF 13 NEONATES BORN TO SYPHILIS WOMEN

Objective To study the clinical features of congenital syphilis (CS) and the relationship of maternal syphilis treatment with morbidity of congenital syphilis in neonates. Methods Thirteen neonates, whose mothers were diagnosed as syphilis, were typed by clinical manifestations and given X-ray examination, immunoassay and follow-up. Results During neonatal period, 5 newborns were diagnosed as CS, 3 were suspected and the remains were normal. Among 5 diagnosed cases, 3 were born to women who had never been treated before delivery; 1 maternal serum RPR titers at delivery decreased less 4 times than that before treatment, 4 serum RPR titers more than 1 -4 at delivery as well, 3 neonatal serum RPR tilers decreased at least four fold in comparison with their mother's. Clinical manifestalions of CS included pre-maturity, hepatosplenomegaly and rash, etc. Primary sign of CNS involvement lay in protein increase in cerebral spinal fluid. Among 13 cases, 1 diagnosed and 1 normal infants miss followed; 1 diagnosed in-fanl was treated repeatly, the other 3 diagnosed infanls' had decreased RPR liters; RPR tests of all the suspected neonates turned negative in 4 months and that of normal infants maintained negalive. Conclusion CS should be diagnosed in light of clinical signs, radiograph and immunoassay because clinical fealures of CS developed alypically in neonalal period. Regular prenalal monitor and appropriate treatment during pregnancy can decrease the morbidily and severity of CS.