梅毒孕妇所产56例新生儿血清学随访结果分析

摘要

Objective To explore the influence of toluidine red unheated serum test ( TRUST) titer of maternal syphilis on neonatal syphilis serology. Methods A total of 56 neonates of mothers with syphilis in Health Care for Women and Children of Zhoushan City delivered between August 2009 and August 2011 were recruited in this study, and they underwent treponema pallidum haemagglutination ( TPHA) and TRUST at birth. Serology detection was done at 3, 6, 9, 12 and 18 months old, and the serology indexes were followed up for analysis. Results There were 3 of 56 neonates diagnosed with congenital syphilis at birth, including 2 premature neonates died after birth and one case accepting standard treatments in hospital. At birth TPHA was positive in 53 suspected cases, and TRUST was positive in 12 (22. 64%) neonates with the titer ranging from1:1 to 1:4. Except for one case lost in follow-up, all of the other cases became negative for TPHA within 18 months, and 12 cases became negative in TRUST within 6 months after birth. The titer of TRUST did not increase for all neonates during follow-up. Congenital syphilis was ruled out in 52 suspected cases. Conclusion Regular and standard anti-syphilis treatment for early and metaphase maternal syphilis can reduce the incidence of congenital syphilis. Long-term follow-up of syphilis serology in neonates improves the cognition on syphilis serology, which can provide assistance for clinical diagnosis and treatment of congenital syphilis.%目的：探讨妊娠梅毒孕妇甲苯胺红不加热血清试验( TRUST)滴度对其所产新生儿梅毒血清学的影响。方法对舟山市妇幼保健院2009年8月至2011年8月期间56例妊娠梅毒母亲所生56例新生儿于出生时进行梅毒螺旋体血细胞凝试验( TPHA)和TRUST检测,于生后3、6、9、12和18月龄时进行血清学检测,并对梅毒血清学指标进行随访,对治疗结果进行分析。结果56例新生儿中,3例新生儿于出生时诊断为先天梅毒儿,其中2例为早产儿于出生后死亡,1例住院予正规治疗。53例疑似先天梅毒儿,出生时TPHA均为阳性,12例(22.64%)TRUST为阳性,滴度1：1~1：4；52例(1例失访)随访对象的TPHA于18个月龄时全部转阴,12例新生儿阳性TRUST于6月龄时全部转阴,所有病例在随访期间未出现TRUST滴度上升,至随访结束,52例疑似先天梅毒儿均排除了先天梅毒感染的可能。结论对妊娠早、中期发现的梅毒患者通过正规、足量的抗梅毒治疗可以降低先天性梅毒的发生率。通过对新生儿进行长期的梅毒血清学随访,提高了对梅毒血清学的认识,可为临床诊断和治疗先天性梅毒提供帮助。