梅毒螺旋体IgM抗体蛋白印迹试验诊断新生儿胎传梅毒的探讨

目的探讨梅毒螺旋体IgM抗体蛋白印迹试验(Treponema pallidum IgM Western blot，TP-IgM-WB)在新生儿胎传梅毒早期诊断中的价值。方法对8例胎传梅毒新生儿(其母亲均为梅毒)进行TRUST、TPPA，FTA-ABS-19S-IgM和TP-IgM-WB 4种梅毒血清学检查，并结合临床对结果进行比较。结果8例中3例出现胎传梅毒的典型临床表现，包括典型皮肤损害，梅毒新生儿肺炎，伴发心、脑、肝、肾多脏器衰竭；另外5例无胎传梅毒的临床表现。梅毒血清学试验结果：所有8例TP-IgM-WB均为阳性；除1例外，7例FTA-ABS-19S-IgM试验为阳性；3例有症状的胎传梅毒及3例胎传潜伏梅毒中4种梅毒血清学试验均为阳性；1例TRUST和TPPA均阴性，但FTA-ABS-19S-IgM和TP-IgM-WB均阳性；1例FTA-ABS-19S-IgM阴性，但TRUST滴度是母亲的4倍，TPPA和TP-IgM-WB均阳性。结论梅毒螺旋体IgM抗体蛋白印迹试验可作为一种确诊试验应用于新生儿胎传梅毒，尤其是胎传潜伏梅毒的早期诊断。

Diagnosis of Neonatal Congenital Syphilis with Treponema pallidum IgM Western Blot

Objective To evaluate the clinical usefulness of Treponema pallidum IgM Western blot (TP-IgM-WB) test in the diagnosis of neonatal congenital syphilis. Methods Eight cases of neonatal congenital syphilis, whose mothers were diagnosed as syphilis at different pregnant stages, were tested by TRUST, TPPA, FTA-ABS-19S-IgM and TP-IgM-WB. The results and clinical manifestations were analysed. Results Three of 8 cases presented clinical manifestations of congenital syphilis, including typical cutaneous lesions, syphilitic pneumonia, and multi-system failure. The others were asymptomatic. In all 8 cases TP-IgM-WB was positive. Of them 7 cases FTA-ABS-19S-IgM was positive. Six cases (including 3 symptomatic) were positive to all four tests. One case was positive to FTA-ABS-19S-IgM and TP-IgM-WB, but negative to TRUST and TPPA. One case was negative to FTA-ABS-19S-IgM, but positive to TPPA, TP-IgM-WB and TRUST, and TRUST titer was 4 times as high as her mother. Conclusions In view of its high specificity and sensitivity, TP-IgM-WB could be used as a confirmatory test for the diagnosis of both symptomatic and asymptomatic neonatal congenital syphilis.