本文選題：先天性梅毒 + 產(chǎn)前保健��； 參考：《復(fù)旦大學(xué)》2012年碩士論文

【摘要】：目的通過(guò)回顧分析1999年至2009年復(fù)旦大學(xué)附屬兒科醫(yī)院收治的先天性梅毒高危兒的病歷資料,以了解收治的先天性梅毒高危兒的評(píng)估、分類情況,探討先天性梅毒相關(guān)的母親特征,分析先天性梅毒臨床特征及先天性梅毒高危兒治療情況。 方法本研究回顧了1999年-2009年復(fù)旦大學(xué)附屬兒科醫(yī)院收治的先天性梅毒高危兒病歷資料,收集的信息包括母親特征(年齡、職業(yè)、戶籍、流產(chǎn)史、梅毒產(chǎn)前診治特征)、患兒一般特征、患兒臨床評(píng)估結(jié)果。本研究參照美國(guó)疾病預(yù)防控制中心(CDC)先天性梅毒監(jiān)測(cè)定義,結(jié)合母親產(chǎn)前梅毒診治情況及患兒臨床評(píng)估結(jié)果將先天性梅毒高危兒分為先天性梅毒病例和其他先天性梅毒高危兒,其中具有臨床異常特征(包括特征性皮疹、肝脾腫大、長(zhǎng)骨片異常、或19S-lgM陽(yáng)性)的病例稱為臨床先天性梅毒病例；比較臨床先天性梅毒病例和其他患兒(包括其他先天性梅毒病例及其他先天性梅毒高危兒)母親相關(guān)特征；比較產(chǎn)前正規(guī)治療和非正規(guī)治療母親相關(guān)特征：描述臨床先天性梅毒病例及19S-lgM陽(yáng)性先天性梅毒病例臨床特征；分析先天性梅毒高危兒青霉素治療時(shí)間、住院費(fèi)用及出院前RPR轉(zhuǎn)歸。 結(jié)果(1)先天性梅毒高危兒評(píng)估、分類情況：1999年至2009年間共收治1670例先天性梅毒高危兒。先天性梅毒高危兒數(shù)量逐年迅速增加,從1999年10例、2004年的92例、直至2009年的368例。58.3%(973/1670)患兒生后1天內(nèi)入院,3.9%(65/1670)入院時(shí)年齡大于28天。早產(chǎn)比率為12.6%(208/1650)、低出生體重比率為10.6%(177/1637),剖宮產(chǎn)比率為55.8%(932/1670)。僅30.2%(503/1670)患兒母親為孕前或者孕早期篩查發(fā)現(xiàn)梅毒；大于產(chǎn)前4周使用青霉素治療的比例為25.8%(43]/1670),未治療比例為31.8%(531/1670)。先天性梅毒高危兒體格檢查異常(包括特征性皮疹或者肝脾腫大)比例為13.5%(225/1670),血清19S-lgM陽(yáng)性率為11%(157/1422),長(zhǎng)骨片異常率為13.2%(208/1578)。1670例先天性梅毒高危兒參照美國(guó)CDC先天性梅毒監(jiān)測(cè)定義,分為先天性梅毒病例1319例(包括臨床先天性梅毒病例407例),其他先天性梅毒高危兒351例。(2)先天性梅毒相關(guān)母親特征：1598例上海市出生先天性梅毒高危兒納入本分析,其中臨床先天性梅毒病例383例,其他患兒1215例(包括其他先天性梅毒病例869例及其他先天性梅毒高危兒346例)。通過(guò)單因素比較發(fā)現(xiàn),母親年齡小、經(jīng)濟(jì)狀況相對(duì)劣勢(shì)、初產(chǎn)、梅毒篩查時(shí)間晚、未接受治療、母親RPR滴度≥1：8、母親19S-lgM陽(yáng)性與臨床先天性梅毒的發(fā)生明顯相關(guān)。通過(guò)比較424例接受正規(guī)治療的母親和1174例未接受正規(guī)治療的母親相關(guān)特征,發(fā)現(xiàn)非本地戶籍與母親非正規(guī)治療(未接受治療、治療起始時(shí)間小于產(chǎn)前4周、治療情況不詳、非青霉素治療)明顯相關(guān)。(3)臨床先天性梅毒病例臨床特征：407例臨床先天性梅毒病例中,新生兒病例363例,新生兒期后病例44例。和新生兒臨床先天性梅毒病例相比,新生兒期后臨床先天性梅毒病例臨床異常特征比例更高,包括肝腫大(65.1%vs.25.1%,p0.001),脾腫大(39.5%vs.15.8%, p=0.001), RPR滴度≥1:8(59.1%vs.39.7%, p=0.014),19S-lgM陽(yáng)性(67.7%vs.42.3%,p=0.005),貧血(72.7%vs.19.0%, p0.001), CRP升高(53.1%vs.26.9%,p=0.002)。和足月新生兒臨床先天性梅毒病例相比,早產(chǎn)新生兒先天性梅毒病例臨床異常特征更多：肝腫大(40.2%vs18.4%,p0.001),脾腫大(28.9%vs.10%, p0.001), RPR滴度≥1:8(70.8%vs.27.7%, p0.001),19S-lgM陽(yáng)性(70.4%vs.31.6%,p0.001),貧血(29.9%vs.14%,p=0.001),血小板減少(38.1%vs.8.9%, p0.001), CRP升高(51.7%vs.16.7%,p0.001),長(zhǎng)骨片異常(60.2%vs.46.6%, p=0.025)。(4)19S-IgM陽(yáng)性病例臨床特征分析：130例19S-lgM陽(yáng)性新生兒先天性梅毒病例中包括72例足月病例及58例早產(chǎn)病例。和足月19S-lgM陽(yáng)性病例相比,早產(chǎn)19S-lgM陽(yáng)性病例臨床異常特征更多：特征性皮疹(36.2%vs.9.7%,p0.001),肝腫大(51.7%vs.25%,p=0.02),脾腫大(32.8%vs.15.4%, p=0.02), RPR滴度≥1：8(96.6%vs.70.8%,p0.001),血小板減少(43.1%vs.23.6%, p=0.018), CRP升高(65.5%vs.36.5%,p=0.002),長(zhǎng)骨片異常(46.4%vs.20.9%,p=0.003)。早產(chǎn)19S-lgM陽(yáng)性病例母親未接受產(chǎn)前梅毒診治的比例高(40.3%vs.15.5%,p=0.003)。早立19S-lgM陽(yáng)性病例放棄治療比例較足月兒高(31%vs.12.9%,p=0.012)。(5)先天性梅毒高危兒治療和出院隨訪時(shí)RPR轉(zhuǎn)歸：64.1%(1045/1670)患兒接受10-14天青霉素治療,2009年共收治368例先天性梅毒高危兒,臨床先天性梅毒病例平均住院費(fèi)用為7087元,其他先天性梅毒病例平均住院費(fèi)用為4773元,其他先天性梅毒高危兒平均住院費(fèi)用為4218元。1670例先天性梅毒高危兒中入院后共有388人進(jìn)行RPR復(fù)查,其中臨床先天性梅毒病例28.4%(110/388),19S-lgM陽(yáng)性病例比例為19.9%(61/307)；入院7天至30天復(fù)查比例為84.8%(329/388),入院時(shí)RPR陰性患兒中10.4%(23/221)患兒出現(xiàn)RPR轉(zhuǎn)為陽(yáng)性,RPR1：8的患兒58.6%(58/99)轉(zhuǎn)為陰性,RPR≥1：8患兒45.6%(31/68)患兒轉(zhuǎn)為RPR1：8或者陰性。 結(jié)論(1)1999-2009年先天性梅毒高危兒收治人數(shù)迅速上升,產(chǎn)前梅毒診治仍需加強(qiáng)；但是臨床先天性梅毒病例未出現(xiàn)相似的快速增長(zhǎng),提示孕期梅毒篩查制度在預(yù)防先天性梅毒的發(fā)生中發(fā)揮了重要作用。(2)先天性梅毒的發(fā)生與母親相對(duì)劣勢(shì)的社會(huì)經(jīng)濟(jì)學(xué)狀況、不恰當(dāng)?shù)哪赣H梅毒產(chǎn)前診治(篩查時(shí)間晚、或者不治療)及母親梅毒處于活動(dòng)期明顯相關(guān)。(3)新生兒期后住院臨床先天性梅毒病例臨床異常特征較新生兒期住院病例多,早產(chǎn)新生兒臨床先天性梅毒病例臨床異常特征較足月新生兒多,提示先天性梅毒的臨床表現(xiàn)多樣,先天性梅毒的臨床診斷仍存在困難,包括血清學(xué)診斷,骨梅毒診斷,神經(jīng)梅毒診斷等。(4)早產(chǎn)19S-IgM陽(yáng)性先天性梅毒病例受累嚴(yán)重程度較足月病例重。(5)先天性梅毒的評(píng)估、診斷、治療、預(yù)防仍需要加強(qiáng)規(guī)范；尚需加強(qiáng)新生兒科、產(chǎn)科、衛(wèi)生管理等多部門之間臨床信息的共享。
[Abstract]:Objective through a retrospective analysis of the medical records of congenital syphilis in the Paediatrics Hospital Affiliated to Fudan University from 1999 to 2009, in order to understand the evaluation and classification of congenital syphilis, the characteristics of congenital syphilis related mothers were discussed, the clinical characteristics of congenital syphilis and the treatment of congenital syphilis high risk infants were analyzed. Condition.
Methods this study reviewed the medical records of congenital syphilis in the Paediatrics Hospital Affiliated to Fudan University in 1999 -2009, and collected information including the characteristics of mother (age, occupation, household registration, abortion history, the characteristics of prenatal diagnosis and treatment of syphilis), the general characteristics of the children and the clinical evaluation results of the children. The study referred to the center for disease prevention and control of the United States (CDC The definition of congenital syphilis monitoring, combined with the diagnosis and treatment of prenatal syphilis and the clinical evaluation of the children, divided the congenital syphilis high-risk infants into congenital syphilis cases and other congenital syphilis high risk infants, which have clinical abnormal characteristics (including characteristic rash, hepatomegaly, long bone abnormality, or 19S-lgM positive) cases known as the face of the disease. Cases of congenital syphilis in bed; comparison of the related characteristics of clinical congenital syphilis cases and other children (including other congenital syphilis cases and other congenital syphilis high risk children); compare the related characteristics of the normal prenatal treatment and the irregular treatment of the mother: describe the clinical congenital malx cases and the 19S-lgM positive congenital syphilis cases The clinical characteristics of children with congenital syphilis were analyzed. The penicillin treatment time, hospitalization expenses and RPR outcome before discharge were analyzed.
Results (1) assessment of congenital syphilis high-risk infants, classification: from 1999 to 2009, 1670 cases of congenital syphilis high risk infants were treated. The number of congenital syphilis high-risk infants increased rapidly year by year, from 10 cases in 1999, 92 in 2004, 368 cases of.58.3% (973/1670) in 2009 and 1 days after birth, and 3.9% (65/1670) more than 28 at admission. The rate of preterm birth was 12.6% (208/1650), the rate of low birth weight was 10.6% (177/1637) and the cesarean section rate was 55.8% (932/1670). Only 30.2% (503/1670) mothers were screened for syphilis before or in early pregnancy; the ratio of penicillin for the 4 weeks prior to birth was 25.8% (43]/1670), and 31.8% (531/1670) was untreated. Congenital syphilis The proportion of abnormal physical examination (including characteristic rash or hepatomegaly) was 13.5% (225/1670), the positive rate of serum 19S-lgM was 11% (157/1422), the abnormal rate of long bone was 13.2% (208/1578), and the high risk infants in.1670 cases of congenital syphilis were divided into 1319 cases of congenital syphilis (including congenital congenital syphilis, including congenital congenital syphilis). 407 cases of syphilis cases, 351 cases of other congenital syphilis high risk children. (2) congenital syphilis related mother characteristics: 1598 cases of congenital syphilis high-risk infants born in Shanghai were included in this analysis, including 383 cases of congenital syphilis and 1215 cases of other children (including 869 cases of other congenital syphilis and 346 cases of other congenital syphilis cases). Through single factor comparison, it was found that mother's age is small, economic situation is relatively inferior, primary birth, screening time of syphilis late, untreated, mother's RPR titer more than 1:8, mother 19S-lgM positive and clinical congenital syphilis. By comparing 424 mothers with regular treatment and 1174 mothers who have not received regular treatment. The clinical features of non local domicile and mother's irregular treatment (untreated, initial time less than 4 weeks prior to birth, unknown treatment, non penicillin) were significantly related. (3) clinical features of congenital syphilis cases: 407 cases of congenital syphilis, 363 newborns, 44 postneonatal cases. Compared with congenital syphilis cases, the clinical abnormal characteristics of congenital syphilis cases were higher in newborns, including 65.1%vs.25.1% (p0.001), splenomegaly (39.5%vs.15.8%, p=0.001), RPR titer more than 1:8 (59.1%vs.39.7%, p=0.014), 19S-lgM Yang (67.7%vs.42.3%, p=0.005), anemia (72.7%vs.19.0%,), increased (53.1 %vs.26.9%, p=0.002). Compared with the clinical congenital syphilis cases in full-term newborns, the clinical abnormal characteristics of congenital syphilis in premature newborns are more characterized by hepatomegaly (40.2%vs18.4%, p0.001), splenomegaly (28.9%vs.10%, p0.001), RPR titer more than 1:8 (70.8%vs.27.7%, p0.001), 19S-lgM positive (70.4%vs.31.6%, p0.001), anemia, and anemia. Thrombocytopenia (38.1%vs.8.9%, p0.001), CRP elevation (51.7%vs.16.7%, p0.001), long bone fragment anomaly (60.2%vs.46.6%, p=0.025). (4) analysis of the clinical characteristics of 19S-IgM positive cases: 130 cases of congenital syphilis of 19S-lgM positive neonates include 72 cases of full term disease and 58 cases of premature delivery. Compared with full term 19S-lgM positive cases, the premature birth is 19S-lgM. The clinical abnormal characteristics of the positive cases were more: 36.2%vs.9.7% (p0.001), hepatomegaly (51.7%vs.25%, p=0.02), splenomegaly (32.8%vs.15.4%, p=0.02), RPR titer more than 1:8 (96.6%vs.70.8%, p0.001), thrombocytopenia (43.1%vs.23.6%, p=0.018), abnormal long bones, preterm birth. 19S-lgM positive cases mothers did not receive prenatal diagnosis and treatment of syphilis (40.3%vs.15.5%, p=0.003). The rate of abandonment of early 19S-lgM positive cases was higher than that of full moon (31%vs.12.9%, p=0.012). (5) the treatment of congenital syphilis high-risk infants and the follow-up of the discharge of RPR: 64.1% (1045/1670) children received 10-14 days penicillin treatment, in 2009, a total of patients were treated. 368 cases of congenital syphilis high risk infants, the average hospitalization cost of clinical congenital syphilis was 7087 yuan, the average hospitalization expenses of other congenital syphilis cases were 4773 yuan, the average hospitalization expenses of other congenital syphilis infants were 4218 yuan.1670 cases, and 388 patients were reexamined after admission to the high risk children of congenital syphilis, including clinical congenital plum. The proportion of 19S-lgM positive cases was 28.4% (110/388), and the proportion of 19S-lgM positive cases was 84.8% (61/307); 10.4% (23/221) of children with RPR negative children were turned positive at admission, 58.6% (58/99) to negative in RPR1:8, and 45.6% (31/68) children in RPR > 1:8 children.
Conclusion (1) the number of patients with congenital syphilis at high risk increased rapidly in 1999-2009 years, and the diagnosis and treatment of prenatal syphilis still needs to be strengthened. However, there is no similar rapid growth in the clinical congenital syphilis cases. It suggests that the screening system of syphilis plays a important role in preventing the occurrence of congenital syphilis. (2) congenital syphilis is relative to the mother. The status of inferior social economics, inappropriate prenatal diagnosis and treatment of syphilis (late screening time, or non treatment) and mother syphilis in the active period were significantly related. (3) the clinical abnormal characteristics of congenital syphilis cases in hospitalized neonates were more than those in newborns, and the clinical abnormality of clinical congenital syphilis cases in premature newborn infants The clinical manifestations of congenital syphilis are diverse and the clinical manifestations of congenital syphilis are varied. The clinical diagnosis of congenital syphilis is still difficult, including serological diagnosis, diagnosis of bone syphilis, diagnosis of neurosyphilis. (4) the seriousness of premature 19S-IgM positive congenital syphilis cases is more serious than that of full term cases. (5) assessment, diagnosis and treatment of congenital syphilis. Prevention still needs to be strengthened, and the sharing of clinical information between departments of Pediatrics, obstetrics, and health management is needed.

【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R759.1

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2 雷巧玲;77例先天性梅毒臨床特點(diǎn)分析[D];重慶醫(yī)科大學(xué);2010年

3 劉潤(rùn)秋;國(guó)內(nèi)二期顯性梅毒皮疹的變遷[D];蘇州大學(xué);2010年

4 鄧秀娥;梅毒患者血液47KDa、15KDa膜免疫原基因的測(cè)定[D];蘭州大學(xué);2012年

5 劉瑞霞;捕獲法ELISA檢測(cè)TP-IgM抗體在各期梅毒的診斷及療效觀察方面的臨床應(yīng)用[D];中國(guó)醫(yī)科大學(xué);2010年

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