早期梅毒465例临床及病理分析

目的：了解早期梅毒临床表现及误诊原因，探讨组织病理学在梅毒诊断中的意义。方法：对465例早期梅毒进行了临床分析，所有患者均作梅毒血清学检测，其中28例做了病理学检查。结果：一期梅毒81例，RPR(快速血浆反应素试验)及TPPA(梅毒螺旋体抗体凝集试验)阳性79例；二期梅毒361例，RPR及TPPA均呈阳性；隐性梅毒20例，RPR及TPPA均呈阳性。一期梅毒易误诊为软下疳、生殖器疱疹、疥疮结节、女阴溃疡等；二期梅毒斑疹及斑丘疹易误诊为玫瑰糠疹、过敏性皮炎等；鳞屑性丘疹易误诊为银屑病；扁平湿疣易误诊为尖锐湿疣等。结论：梅毒血清学检测对早期梅毒的诊断具有重要意义，病理检查对硬下疳、扁平湿疣、鳞屑性丘疹皮疹诊断有一定意义，而斑疹呈非特异性炎症改变，不具诊断意义。

Clinical and Pathological Analysis on 465 Cases with Early Stage Syphilis

Objective:To study the clinic feature and cause of misdiagnosis of early syphilis and evaluate the significance of histopathology in diagnosis of syphilis. Methods:465 cases with early syphilis were analyzed. The serologic test for syphilis were performed. 28 of them were performed with histopathologyical examination. Results:The primary syphilis was found to be commonly misdiagnosed as chancroid, genital herpes, scabies nodules and ulcus vulvae acutum. For secondary syphilis, macular syphilide and maculopapular syphilide were easily misdiagnosed as pityriasis rosea or dermatitis. The papulosquamous syphilide were commonly misdiagnosed as psoriasis. The condyloma latum were commonly misdiagnosed as condylom acuminatum. Conclusion:The serologic test is important in diagnosis of primary syphilis. The histopathologic test is significant in diagnosis of primary syphilis, condylomas latum and papulosquamous syphilide, but of limitid value in diagnosis of macular syphilide.