Beeram M R, Chopde N, Dawood Y, Siriboe S, Abedin M
Department of Pediatrics, District of Columbia General Hospital, Howard University College of Medicine, Washington, D.C., USA.
J Pediatr. 1996 Jan;128(1):125-9. doi: 10.1016/s0022-3476(96)70441-9.
To evaluate the usefulness of lumbar puncture (LP) in the initial evaluation of symptom-free infants for congenital syphilis.
We retrospectively studied infants who had successful LPs and were born to untreated or inadequately treated seropositive women between 1990 and 1993 in two hospitals in Washington, D.C. We identified 329 such symptom-free infants (syphilis group). The cerebrospinal fluid (CSF) VDRL was reactive in two (0.6%) infants. The CSF leukocyte and protein concentrations of these infants were compared with those in 84 symptom-free control infants who were born to seronegative women and who had LPs performed in 1993 to rule out sepsis because of associated risk factors. Control infants had negative results for bacterial cultures (CSF and blood) and bacterial antigen tests (CSF and urine).
Thirty control subjects and 67 infants in the syphilis group had traumatic taps (CSF erythrocytes > 500 x 10(6)/L), and hence were excluded from the analysis of cell count and proteins. Birth weights and gestational ages were similar in both groups. The CSF leukocyte and protein values were similar in the syphilis group and in control infants: mean CSF leukocytes 7.7 x 10(6)/L (mean 7.7/mm3, range 0 to 57/mm3, SD 8.8) versus 6.9 x 10(6)/L (mean 6.9/mm3, range 0 to 31/mm3, SD 7), p = 0.5, and mean protein concentration 981 mg/L (range 270 to 2280 mg/L, SD 376) versus 936 mg/L (range 360 to 1750 mg/L, SD 368), p = 0.96, respectively. The combination of CSF leukocyte values > 5 x 10(6)/L (> 5/mm3) or protein values > 400 mg/L (> 40 mg/dl) was found in 97.8% of the infants in the syphilis group, compared with 95.3% of the control group.
Because of the low yield of reactive CSF VDRL and the similar CSF leukocyte and protein values in the syphilis group and the control infants, the role of routine LP in the initial evaluation of symptom-free infants for congenital syphilis should be reconsidered.
评估腰椎穿刺（LP）在无症状婴儿先天性梅毒初始评估中的作用。
我们回顾性研究了1990年至1993年期间在华盛顿特区两家医院成功进行腰椎穿刺且母亲为未经治疗或治疗不充分的血清学阳性女性所生的婴儿。我们确定了329名此类无症状婴儿（梅毒组）。其中两名（0.6%）婴儿的脑脊液（CSF）性病研究实验室玻片试验（VDRL）呈阳性反应。将这些婴儿的脑脊液白细胞和蛋白质浓度与84名无症状对照婴儿进行比较，这些对照婴儿的母亲为血清学阴性，于1993年因相关危险因素进行腰椎穿刺以排除败血症。对照婴儿的细菌培养（脑脊液和血液）及细菌抗原检测（脑脊液和尿液）结果均为阴性。
30名对照受试者和梅毒组的67名婴儿出现穿刺损伤（脑脊液红细胞>500×10⁶/L），因此被排除在细胞计数和蛋白质分析之外。两组的出生体重和孕周相似。梅毒组婴儿和对照婴儿的脑脊液白细胞和蛋白质值相似：脑脊液白细胞平均为7.7×10⁶/L（平均7.7/mm³，范围0至57/mm³，标准差8.8），而对照婴儿为6.9×10⁶/L（平均6.9/mm³，范围0至31/mm³，标准差7），p = 0.5；蛋白质平均浓度分别为981 mg/L（范围270至2280 mg/L，标准差376）和936 mg/L（范围360至1750 mg/L，标准差368），p = 0.96。梅毒组97.8%的婴儿脑脊液白细胞值>5×10⁶/L（>5/mm³）或蛋白质值>400 mg/L（>40 mg/dl），对照组这一比例为95.3%。
由于脑脊液VDRL阳性率低，且梅毒组婴儿和对照婴儿的脑脊液白细胞和蛋白质值相似，应重新考虑常规腰椎穿刺在无症状婴儿先天性梅毒初始评估中的作用。
