Long W A, Ulshen M H, Lawson E E
J Pediatr Gastroenterol Nutr. 1984 Sep;3(4):551-5. doi: 10.1097/00005176-198409000-00013.
To study the clinical course and biochemical features of congenital syphilitic hepatitis, the records of all 22 pediatric patients admitted to North Carolina Memorial Hospital between 1969 and 1979 with a positive maternal, cord blood, or serum VDRL were reviewed. Of the seven infants identified with symptomatic congenital syphilis, five had clinical and biochemical evidence of liver dysfunction. All five were jaundiced (peak bilirubin ranged from 8.4 to 29.8 mg/dl, in each case greater than 40% conjugated). Peak transaminase elevation ranged from seven to 150 times normal. Serum glutamic-oxaloacetic transaminase exceeded serum glutamic-pyruvic transaminase in each infant, the difference ranging to 7,400 U. The onset of illness did not occur until after treatment had been initiated in two of these five cases. Liver dysfunction increased with treatment in all four infants with serial enzyme determinations. Liver dysfunction also persisted for more than 6 weeks after adequate treatment in two cases. Liver biopsy 5 weeks after treatment in another infant showed giant cell hepatitis. These observations suggest that treatment can potentiate liver dysfunction in congenital syphilis and that viable treponemes are not necessarily essential in the pathogenesis of the hepatitis.
为研究先天性梅毒肝炎的临床病程及生化特征，回顾了1969年至1979年间入住北卡罗来纳纪念医院的所有22例儿科患者的记录，这些患者的母亲、脐血或血清性病研究实验室试验（VDRL）呈阳性。在确诊为有症状先天性梅毒的7例婴儿中，5例有肝功能障碍的临床及生化证据。所有5例均有黄疸（胆红素峰值范围为8.4至29.8mg/dl，每例结合胆红素均超过40%）。转氨酶峰值升高范围为正常的7至150倍。每例婴儿血清谷草转氨酶均超过谷丙转氨酶，差值达7400U。在这5例中的2例中，直到开始治疗后才发病。对4例婴儿进行系列酶测定，结果显示肝功能障碍随治疗而加重。在2例中，充分治疗后肝功能障碍持续超过6周。另一例婴儿在治疗5周后肝活检显示巨细胞肝炎。这些观察结果表明，治疗可使先天性梅毒的肝功能障碍加重，并且在肝炎发病机制中，活梅毒螺旋体不一定是必需的。
