77例先天性梅毒臨床特點(diǎn)分析
發(fā)布時間：2018-10-12 15:25
【摘要】： 目的: 研究77例先天性梅毒(congenital syphilis,CS)的臨床特點(diǎn)。 方法: 收集重慶醫(yī)科大學(xué)附屬兒童醫(yī)院2006年2月至2009年11月住院確診為CS 77例患兒的病例資料,分別按新生兒期與非新生兒期、有無合并其他TORCH感染分組,分析主要的臨床表現(xiàn)、多系統(tǒng)損害和實(shí)驗(yàn)室檢查方面的特點(diǎn),并隨訪TRUST結(jié)果。 結(jié)果: 1.77例CS患兒多系統(tǒng)損害的發(fā)生率從高到低依次是:呼吸系統(tǒng)、消化系統(tǒng)、皮膚、血液系統(tǒng),消化系統(tǒng)中轉(zhuǎn)氨酶升高以AST為主。 2.實(shí)驗(yàn)室檢查,77例CS患兒中實(shí)驗(yàn)室檢查異常的陽性率高低依次是:凝血象88.9%(16/18)、長骨X片76.7%(46/60)、心肌酶譜76.3%(29/38)、腎功16.4%(9/55)。 3.新生兒期與非新生兒期在皮疹、鼻阻、水腫、氣促/發(fā)紺、吐奶嗆奶/咳嗽、疑診/體檢、肝脾增大、貧血、顱內(nèi)出血的發(fā)生率上差異有顯著性(P 0.05),而在腹脹、白細(xì)胞升高、血小板減少、轉(zhuǎn)氨酶升高、膽紅素升高、低蛋白、胸片、尿常規(guī)異常上差異無顯著性(P 0.05)。 4.77例CS患兒中37例合并其他TORCH感染,單純CS組與合并其他TORCH感染組在肝脾增大、貧血、血小板減少、轉(zhuǎn)氨酶升高、低蛋白血癥及胸片有陽性發(fā)現(xiàn)的發(fā)生率上及轉(zhuǎn)氨酶升高水平上差異有顯著性(P 0.05),合并其他TORCH感染組其發(fā)生率更高,轉(zhuǎn)氨酶升高更明顯,但在早產(chǎn)、低體重、顱內(nèi)出血、聽力損害、先天性心臟病發(fā)生率上差異無顯著性(P 0.05)。 5.77例CS中23例隨訪了TRUST,其中19例轉(zhuǎn)陰,4例隨訪至6月時僅滴度下降。19例CS中1、2、3、6、12、13月時TRUST轉(zhuǎn)陰率分別為26.3%(5/19)、36.8%(7/19)、57.9%(11/19)、78.9%(15/19),94.7%(18/19),100%(19/19)。 結(jié)論: 1.77例CS患兒以呼吸系統(tǒng)、消化系統(tǒng)中轉(zhuǎn)氨酶升高(以AST升高為主)、皮疹、血液系統(tǒng)中貧血、肝脾增大、低蛋白血癥為主要系統(tǒng)損害表現(xiàn)。CS系全身的多系統(tǒng)損害性感染性疾病,其中凝血功能異常、骨損害、心肌損害發(fā)生率高,長骨X線檢查可提供重要診斷依據(jù),建議對CS患兒完善多系統(tǒng)相關(guān)檢查. 2.CS在新生兒期表現(xiàn)常不典型,且與非新生兒期有差異。新生兒期以疑診/體檢就診的無癥狀的CS明顯高于非新生兒期,顱內(nèi)出血的發(fā)生率明顯高于非新生兒期,而非新生兒期的CS患兒的皮疹、鼻阻、水腫、肝脾增大、貧血發(fā)生率更高,較新生兒期更典型,因此對新生兒做CS篩查有重要意義。 3.CS易合并其他TORCH感染,合并其他TORCH感染的CS在呼吸系統(tǒng)、消化系統(tǒng)、血液系統(tǒng)的損害的發(fā)生率上較單純CS組高,所引起的肝脾腫大、貧血、血小板減少、轉(zhuǎn)氨酶升高、低蛋白血癥及呼吸系統(tǒng)損害發(fā)生率顯著增加,轉(zhuǎn)氨酶升高更明顯,肝損害程度更重,但先天性心臟病的發(fā)生率未明顯上升。 4.CS患兒隨訪TRUST,多在6-12月內(nèi)轉(zhuǎn)陰。
[Abstract]:Objective: to study the clinical features of 77 cases of congenital syphilis (congenital syphilis,CS). Methods: from February 2006 to November 2009, 77 children with CS were collected from affiliated Children's Hospital of Chongqing Medical University. The main clinical manifestations, multi-system lesions and laboratory findings were analyzed and TRUST results were followed up. Results: 1.The incidence of multiple system damage in 77 cases with CS was in the order of respiratory system, digestive system, skin, blood system and digestive system. Laboratory examination showed that the positive rate of abnormal laboratory examination was 88.9% (16 / 18), 76.7% (46 / 60), 76.3% (29 / 38) and 16.4% (9 / 55), respectively. There were significant differences in the incidence of rash, nasal obstruction, edema, shortness of breath / cyanosis, dysphagia / cough, suspected diagnosis / physical examination, liver and spleen enlargement, anemia and intracranial hemorrhage (P 0.05). There was no significant difference in thrombocytopenia, transaminase, bilirubin, low protein, chest radiographs and urine routine (P0. 05). In the simple CS group and other TORCH infection groups, the liver and spleen increased, anemia, thrombocytopenia, aminotransferase increased. There were significant differences in the incidence of hypoproteinemia and the positive rate of chest radiographs and the elevated level of aminotransferase (P 0.05). In the group of other TORCH infection, the incidence was higher and the level of transaminase was higher, but in premature delivery, low body weight, intracranial hemorrhage, the incidence of transaminase was higher than that in other groups. There was no significant difference in the incidence of hearing impairment and congenital heart disease (P 0.05). In 5.77 cases of CS, 23 cases were followed up with TRUST, 19 cases turned negative, 4 cases were followed up to 6 months, only the titer decreased. In 19 cases of CS, the negative rate of TRUST was 26.3% (5/ 19), 36.8% (7 / 19), 57.9% (11 / 19), 78.9% (15 / 19), 94.7% (18 / 19), 100% (19 / 19), respectively, at the 13th month, the rate of TRUST negative was 26.3% (5 / 19), 36.8% (7 / 19), 57.9% (11 / 19), 78.9% (15 / 19), 94.7% (18 / 19), 100% (19 / 19) respectively. Conclusions: 1.Respiratory system, elevation of transaminase in digestive system (mainly increased in AST), rash, anemia in blood system, enlargement of liver and spleen were the main causes of CS. Hypoproteinemia is the main systemic lesion. CS is a systemic infectious disease with abnormal coagulation function, high incidence of bone damage and myocardial damage. X-ray examination of long bone can provide important diagnostic basis. It is suggested to improve the multisystem correlation examination for children with CS. The manifestation of 2.CS in neonatal stage is often atypical and different from that in non-neonatal stage. The incidence of intracranial hemorrhage was significantly higher in the neonates with suspected / examined CS than in the non-neonates, and the incidence of intracranial hemorrhage was significantly higher in the neonates than in the non-neonates, while the rash, nasal obstruction, edema, liver and spleen enlargement were found in the non-neonatal CS patients. The incidence of anemia is higher and more typical than the neonatal stage, so it is important to screen for CS in newborns. 3.CS is easy to combine with other TORCH infection, CS with other TORCH infection in respiratory system, digestive system, The incidence of blood system damage was higher than that of simple CS group, resulting in hepatosplenomegaly, anemia, thrombocytopenia, elevated aminotransferase, hypoproteinemia and respiratory system damage. The degree of liver damage was more serious, but the incidence of congenital heart disease did not increase significantly. TRUST, turned negative in 6 to 12 months follow-up in children with 4.CS.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R759.1
本文編號：2266638
[Abstract]:Objective: to study the clinical features of 77 cases of congenital syphilis (congenital syphilis,CS). Methods: from February 2006 to November 2009, 77 children with CS were collected from affiliated Children's Hospital of Chongqing Medical University. The main clinical manifestations, multi-system lesions and laboratory findings were analyzed and TRUST results were followed up. Results: 1.The incidence of multiple system damage in 77 cases with CS was in the order of respiratory system, digestive system, skin, blood system and digestive system. Laboratory examination showed that the positive rate of abnormal laboratory examination was 88.9% (16 / 18), 76.7% (46 / 60), 76.3% (29 / 38) and 16.4% (9 / 55), respectively. There were significant differences in the incidence of rash, nasal obstruction, edema, shortness of breath / cyanosis, dysphagia / cough, suspected diagnosis / physical examination, liver and spleen enlargement, anemia and intracranial hemorrhage (P 0.05). There was no significant difference in thrombocytopenia, transaminase, bilirubin, low protein, chest radiographs and urine routine (P0. 05). In the simple CS group and other TORCH infection groups, the liver and spleen increased, anemia, thrombocytopenia, aminotransferase increased. There were significant differences in the incidence of hypoproteinemia and the positive rate of chest radiographs and the elevated level of aminotransferase (P 0.05). In the group of other TORCH infection, the incidence was higher and the level of transaminase was higher, but in premature delivery, low body weight, intracranial hemorrhage, the incidence of transaminase was higher than that in other groups. There was no significant difference in the incidence of hearing impairment and congenital heart disease (P 0.05). In 5.77 cases of CS, 23 cases were followed up with TRUST, 19 cases turned negative, 4 cases were followed up to 6 months, only the titer decreased. In 19 cases of CS, the negative rate of TRUST was 26.3% (5/ 19), 36.8% (7 / 19), 57.9% (11 / 19), 78.9% (15 / 19), 94.7% (18 / 19), 100% (19 / 19), respectively, at the 13th month, the rate of TRUST negative was 26.3% (5 / 19), 36.8% (7 / 19), 57.9% (11 / 19), 78.9% (15 / 19), 94.7% (18 / 19), 100% (19 / 19) respectively. Conclusions: 1.Respiratory system, elevation of transaminase in digestive system (mainly increased in AST), rash, anemia in blood system, enlargement of liver and spleen were the main causes of CS. Hypoproteinemia is the main systemic lesion. CS is a systemic infectious disease with abnormal coagulation function, high incidence of bone damage and myocardial damage. X-ray examination of long bone can provide important diagnostic basis. It is suggested to improve the multisystem correlation examination for children with CS. The manifestation of 2.CS in neonatal stage is often atypical and different from that in non-neonatal stage. The incidence of intracranial hemorrhage was significantly higher in the neonates with suspected / examined CS than in the non-neonates, and the incidence of intracranial hemorrhage was significantly higher in the neonates than in the non-neonates, while the rash, nasal obstruction, edema, liver and spleen enlargement were found in the non-neonatal CS patients. The incidence of anemia is higher and more typical than the neonatal stage, so it is important to screen for CS in newborns. 3.CS is easy to combine with other TORCH infection, CS with other TORCH infection in respiratory system, digestive system, The incidence of blood system damage was higher than that of simple CS group, resulting in hepatosplenomegaly, anemia, thrombocytopenia, elevated aminotransferase, hypoproteinemia and respiratory system damage. The degree of liver damage was more serious, but the incidence of congenital heart disease did not increase significantly. TRUST, turned negative in 6 to 12 months follow-up in children with 4.CS.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R759.1
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