新生儿先天梅毒及需监视病例的诊断及治疗问题

目的 探讨新生儿先天梅毒（CS）及需监视病例的诊断和治疗问题。方法 回顾性分析1996-07-2000-12我科收治的新生儿CS及需监视病例111例,结果 确诊新生儿CS81例,临床表现复杂,多样化,累及多个脏器,依次为肢端掌趾脱皮、斑疹,肝脾肿大,体重低,呼吸困难,腹胀,梅毒性假麻痹、贫血、黄疸、血小板减少和水肿。梅毒血清学（RPR及TPHA）阳性,无临床表现30例,多为母亲孕期筛查出梅毒或在妊娠晚期感染梅毒且予以驱梅治疗 后所生新生儿,但梅毒血清学检查阳性,以青霉素治疗未发现不良反应,死亡13例,死因均为不可逆的严重多脏器损害,随访26例,体格发育无明显发觉,血RPR6个月时转阴15/22例（68.1%),12个月时转阴20/22例（90.9%),TPHA12个月时转阴10/16例（62.5%)。结论 新生儿CS诊断要依据母亲为梅毒患,临床典型早期CS损害及梅毒血清学检查阳性,对无症状患儿呈梅毒血清学阳性,但因梅素IgG抗体可通过胎盘进入胎儿体内而出现假阳性,应视为可疑病例,监视血清学变化,以青霉素治疗有效,没有不良反应,可疑病例也可通过胎盘进入胎儿体内而出现假阳性,应视为可疑病例,监视血清学变化,以青霉素治疗有效,没有不良反应,可疑病例也可用苄星青霉素肌注2次。

Problem of Diagnosis and Treatmentin Neonate Congenital Syphilis and Suspicious Cases

Objective To explore the problem of diagnosis and treatment in neonate congenital syphilis and suspicious cases.Methods The medical records of 111 cases of congenital syphilis and suspicious cases admitted to the department of neonatology between July,1996 to December,2000 were reviewed.Results The identified neonate congenital syphilis were 81 cases.The clinical manifestations of the disease were complicated,including desquamation of the skin affecting palms and soles,hepatosplenomegaly,low birth weight,respiratory distress,abdomen distention,pseudoparalysis,anaemia,jaundice,thrombocytopenia and edema.Successively no clinical manifestations were 30 cases,but the RPR and TPHA were positive,they were mostly born to the mothers suffering syphilis at pregnancy and be treated.Treatment with benzyl penicillin are effective.13 cases died.The cause of death was the irreversible damage in organs.Follow up of 26 cases,Their physical growth was normal.The negative conversion of RPR test and TPHA occurred at 6 months and 12 months after treatment respectively.Conclusions The diagnosis of neonate congenital syphilis must be according to the mother suffering syphilis,the classical clinical manifestations of early congenital syphilis and positive serology of syphilis.The cases without clinical manifestations but positive serology are needed monitoring for 6 months to 12 months.Treatment with benzyl penicillin are effective,no side effect.