新生儿先天性梅毒诊断准确性的回顾性分析

目的探讨制定统一先天性梅毒(CS)诊断标准的必要性。方法回顾分析2016年1月—2020年2月因母亲梅毒感染而入院的85例新生儿的临床资料,分别采用性传播疾病管理指南(2015)/2015美国儿科学会感染委员会报告(美国指南)、2014年欧洲梅毒管理指南(欧洲指南)和2015年版预防艾滋病、梅毒和乙肝母婴传播工作实施方案(中国方案)进行评估诊断,比较上述三种标准诊断CS的一致性。结果将确诊/高度疑似或疑似病例归入CS,美国指南共诊断32例,欧洲指南诊断40例,中国方案诊断15例,三个标准共诊断40例,其中三个标准均符合者14例。美国指南和中国方案诊断病例均包含于欧洲指南诊断病例,美国指南和中国方案诊断病例重复例数为14例。10例梅毒螺旋体(Tp)试验阳性+长骨X线异常患儿中,7例因母亲孕前或孕期接受规范治疗未被美国指南诊断,其余仅3例因母孕期不规范治疗而被美国指南诊断,10例均未被中国方案诊断。Tp试验阳性+Tp-IgM阳性1例未被美国指南诊断,但均被其他两个标准所诊断。Tp试验阳性+其他指标阴性且母孕期不规范治疗15例未被中国方案诊断,但均被其他两个标准诊断。美国指南与欧洲指南、美国指南和中国方案一致性较强,加权κ值分别为0.611和0.705,而欧洲指南与中国方案一致性一般,加权κ值仅为0.304。结论临床上制定统一的CS诊断标准非常必要。

Retrospective analysis of diagnostic accuracy for congenital syphilis in neonates

Objective To explore the necessity of establishing a unified diagnostic standard for congenital syphilis(CS).Methods The clinical data of 85 newborns admitted for maternal syphilis infection from January 2016 to February 2020 were retrospectively analyzed.The CS diagnosis was evaluated by the Guidelines for the Management of Sexually Transmitted Diseases 2015/Red Book,Infection Association Report 2015(CDC/AAP guidelines),2014 European Syphilis Management Guidelines(European guidelines)and 2015 Implementation Plan for Prevention of Mother-to-child Transmission of HIV/AIDS,Syphilis and Hepatitis B(Chinese criterion)respectively.The consistency of the above three criteria in the diagnosis of CS was compared.Results In the confirmed/highly suspected or suspected cases that were included in CS group,32 cases were diagnosed by CDC/AAP guidelines,40 cases were diagnosed by European guidelines and 15 cases were diagnosed by the Chinese criterion.A total of 40 cases were diagnosed according to the three criteria,among which 14 cases met all the three criteria.The cases diagnosed by the CDC/AAP guidelines and the Chinese criterion are in the cases diagnosed by the European guidelines,and the same cases diagnosed by the CDC/AAP guidelines and the Chinese criterion was 14.Among the 10 children with positive Tp test and abnormal long bone X-rays,7 were not diagnosed by CDC/AAP guidelines because their mothers received standard treatment before or during pregnancy,while the other 3 cases were diagnosed by CDC/AAP due to irregular treatment during pregnancy.None of the 10 cases were diagnosed by the Chinese criterion.One patient with positive Tp test and positive Tp-IgM was not diagnosed by the CDC/AAP guidelines,but was diagnosed by the other two criteria.Fifteen patients with positive Tp test and negative other indexes and irregular treatment during pregnancy were not diagnosed by the Chinese criterion,but were all diagnosed by the other two criteria.The CDC/AAP guidelines have strong consistency with the European guidelines and the Chinese criterion,with the weighted Kappa of 0.611 and 0.705 respectively.However,the consistency between the European guidelines and the Chinese criterion was moderate,with a weighted Kappa of 0.304.Conclusion It is necessary to formulate a unified CS diagnostic criterion in clinical practice.