先天性梅毒 130 例新生儿病例系列：早产儿比足月儿有更多的感染临床证据。

A case series of 130 neonates with congenital syphilis: preterm neonates had more clinical evidences of infection than term neonates.

机构信息

Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.

出版信息

Neonatology. 2012;102(2):152-6. doi: 10.1159/000339291. Epub 2012 Jul 3.

DOI:10.1159/000339291

PMID:22760016

Abstract

BACKGROUND

The early clinical manifestations of congenital syphilis (CS) vary from asymptomatic to florid lesions, involving multisystem damage. But little is known about the differences of early clinical features between preterm and term neonates with CS.

OBJECTIVES

To compare the clinical characteristics between preterm and term neonates with CS and analyze the possible underlying reasons for the differences.

METHODS

Consecutive medical charts of infants at risk for CS from January 1999 to December 2009 were retrospectively reviewed. Neonates with positive 19S-IgM in serum were included in the study.

RESULTS

Among the 1,670 cases at risk for CS, 130 neonatal cases with positive 19S-IgM in serum were included in the analysis, including 58 preterm ones and 72 full-term ones. Compared with term neonates with CS, preterm ones were more likely to have characteristic skin rash (36.2 vs. 9.7%, p < 0.001), hepatomegaly (51.7 vs. 25%, p = 0.02), splenomegaly (32.8 vs. 15.4%, p = 0.02), PRP titer ≥1:8 (96.6 vs. 70.8%, p < 0.001), thrombocytopenia (43.1 vs. 23.6%, p = 0.018), elevated CRP (65.5 vs. 36.5%, p = 0.002), and abnormal long bone X-ray results (94.6 vs. 68.1%, p < 0.001). Fewer mothers of preterm neonates with CS received treatment for syphilis (15.5 vs. 40.3%, p = 0.003). The rate of withdrawal of care was higher in preterm neonates with CS (31 vs.12.5%, p = 0.036).

CONCLUSIONS

Preterm neonates with CS had more clinical evidences and suffered more than term ones.

摘要

背景

先天性梅毒（CS）的早期临床表现从无症状到明显皮损不等，涉及多系统损伤。但对于 CS 早产儿和足月儿的早期临床特征差异知之甚少。

目的

比较 CS 早产儿和足月儿的临床特征，并分析差异的可能原因。

方法

回顾性分析 1999 年 1 月至 2009 年 12 月间有 CS 风险的婴儿病历。纳入血清 19S-IgM 阳性的新生儿。

结果

在 1670 例有 CS 风险的婴儿中，纳入了 130 例血清 19S-IgM 阳性的新生儿病例分析，包括 58 例早产儿和 72 例足月儿。与 CS 足月儿相比，早产儿更有可能出现特征性皮疹（36.2%比 9.7%，p<0.001）、肝肿大（51.7%比 25%，p=0.02）、脾肿大（32.8%比 15.4%，p=0.02）、PRP 效价≥1:8（96.6%比 70.8%，p<0.001）、血小板减少症（43.1%比 23.6%，p=0.018）、CRP 升高（65.5%比 36.5%，p=0.002）和异常长骨 X 线结果（94.6%比 68.1%，p<0.001）。CS 早产儿母亲接受梅毒治疗的比例较低（15.5%比 40.3%，p=0.003）。CS 早产儿放弃治疗的比例较高（31%比 12.5%，p=0.036）。