婴儿初发重症先天性梅毒临床特征及相关因素分析

摘要

目的 分析婴儿初发重症先天性梅毒的临床特征、发病影响因素及死亡危险因素.方法 收集2011年1月-2017年1月中国医科大学附属盛京医院儿科重症监护病房住院治疗的婴儿初发先天性梅毒82例,根据病情程度分为重症组39例及普通组43例.回顾性分析所有患儿的临床资料,总结婴儿初发先天性梅毒的临床特征,并进一步分析重症组发病影响因素及死亡相关因素.结果 82例血清梅毒螺旋体抗体明胶颗粒凝集试验及梅毒血清快速反应素试验均阳性,且效价均高于母血4倍以上.重症组以皮肤黏膜损害、胃肠功能损害和肺损害为主,均合并多器官功能障碍,病死率为22.22%(8/36).年龄较小婴儿、早产儿、农村患儿及发病时间较长是婴儿初发重症先天性梅毒发病的影响因素.单因素分析显示,早产儿、是否机械通气及器官功能障碍数目是婴儿初发重症先天性梅毒死亡危险因素.结论 婴儿初发重症先天性梅毒以皮肤黏膜损害、胃肠功能损害和肺损害为主要临床特征,病死率较高.临床医师应提高对婴儿初发重症先天性梅毒的警惕性,以早期诊断、早期治疗,改善患儿预后.%Objective To analyze clinical characteristics, influencing factors of onset and related factors of death in infants with primary severe congenital syphilis.Methods A total of 82 infants with primary congenital syphilis admitted during January 2011 and January 2017 were divided into severe group (n=39) and common group (n=43) according to disease severity.Clinical data of infants was retrospectively analyzed, and clinical features of infants with primary congenital syphilis were summarized, and onset factors and related factors of fatality in severe group were analyzed.Results Results of serum treponema pallidum particle assay (TPPA) and rapid plasma reagent (RPR) of the 82 infants were positive, and the titer values were four times higher than those of mother's.In severe group, clinical characteristics were mainly skin mucomembranous injury, gastrointestinal function injury and pulmonary injury, and all infants had multiorgans dysfunction, and fatality rate was 22.22% (8/36).Related factors of influencing fatality were younger infants, premature infant, infants in countryside and longer duration of onset for infants with primary severe congenital syphilis (P<0.05).Single factor analysis showed that premature infant, whether or not having mechanical ventilation and numbers of multiorgans dysfunction were the risk factors of fatality.Conclusion Skin mucomembranous injury, gastrointestinal function injury and pulmonary injury are main clinical characteristics of infants with primary severe congenital syphilis, and the fatality rate is high, and therefore clinicians should pay more attention on the disease in order to early diagnosis and treatment and improve prognosis.