中华皮肤科杂志 ›› 2012, Vol. 45 ›› Issue (12): 851-854.

• 论著 • 上一篇    下一篇

梅毒孕妇分娩的新生儿血清学随访

李湘辉1,阳芳2,3,黄少锋2,4,鲁东平5,张荣4,邓宝清2,4   

  1. 1. 深圳市宝安区慢性病防治院
    2.
    3. 武汉市第一医院
    4. 宝安区慢性病防治院
    5. 深圳市宝安区慢性病防治院皮肤科
  • 收稿日期:2012-02-06 修回日期:2012-08-04 出版日期:2012-12-15 发布日期:2012-11-30
  • 通讯作者: 李湘辉 E-mail:jackiefox@126.com

Seroreversion of serological tests for syphilis in neonates born to mothers with syphilis: a follow-up study

  • Received:2012-02-06 Revised:2012-08-04 Online:2012-12-15 Published:2012-11-30

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摘要：

目的 探讨梅毒孕妇分娩的新生儿血清学转归和治疗对未感染梅毒婴儿血清阴转时间的影响。 方法 梅毒孕妇分娩的新生儿115例，出生时进行甲苯胺红不加热血清试验（TRUST）、梅毒螺旋体明胶凝集试验（TPPA）、19S IgM-TPPA检测。在1、3、6、9、12、18、24月龄时进行TRUST和TPPA血清学监测和随访。当TRUST和TPPA均阴性时，终止随访。采用SPSS13.0软件进行Kaplan-Meiter生存分析和两独立样本比较的Wilcoxon秩和检验。结果 115例新生儿出生时TPPA均阳性；97例TRUST阳性，滴度从1 ∶ 1到1 ∶ 256不等；3例19S IgM-TPPA阳性。出生时确诊胎传梅毒3例，TRUST均在12 ～ 18月龄内转阴，2例24月龄时TPPA仍阳性，另1例20月龄时TPPA阳性，仍在随访中。112例疑似病例随访后均排除梅毒感染，90例TRUST在0 ～ 3、4 ～ 6、7 ～ 9月龄时的累计阴转率分别为82.2%、98.9%、100%。96例TPPA在0 ～ 3、4 ～ 6、7 ～ 9、10 ～ 12月龄时的累计阴转率分别为3.1%、30.2%、85.4%、100%。余16例缺部分复查，TRUST和TPPA在15月龄时均转阴。血清阳性未感染梅毒婴儿，出生后苄星青霉素G治疗组与未治疗组TRUST阴转时间差异无统计学意义（χ2 = 0.54，P ＞ 0.05），TPPA阴转时间差异亦无统计学意义（χ2 = 2.41，P ＞ 0.05）。TRUST阴转时间显著早于TPPA阴转时间（Z = 10.45，P ＜ 0.01）。 结论 梅毒孕妇分娩的未感染梅毒婴儿，大多数婴儿TRUST在6月龄内转阴，TPPA在12月龄内转阴；TRUST阴转时间早于TPPA，治疗对TRUST和TPPA阴转时间无影响。

关键词: 梅毒血清诊断

Abstract:

Objective To observe the seroreversion of serological tests for syphilis in neonates born to mothers with syphilis and to evaluate the influence of antisyphilitic treatment on the time of seroreversion in uninfected neonates. Methods A total of 115 neonates born to mothers with syphilis were recruited in this study, and underwent toluidine red unheated serum test （TRUST）, Treponema pallidum particle assay （TPPA）and 19S IgM-TPPA at birth. Follow up was scheduled at 1, 3, 6, 9, 12, 18 and 24 months of age, and cancelled as soon as both TRUST and TPPA became negative during the 24 months. Both TRUST and TPPA were carried out at each follow-up visit. Kaplan-Meiter survival analysis and Wilcoxon rank-sum test were conducted to assess these data by using SPSS 13.0 software. Results At birth, TPPA was positive in all（100%） of the neonates, TRUST in 97 neonates （84.3%） with the titer ranging from 1︰1 to 1 ∶ 256, 19S IgM-TPPA in 3 neonates who were diagnosed with congenital syphilis（CS）. CS was ruled out in the other 112 neonates with negative 19S IgM-TPPA after follow up. Of the 3 neonates with CS, all became negative for TRUST within 12－18 months after birth, 2 remained positive for TPPA at 24 months of age, 1 remained positive for TPPA at 20 months of age, and all were still followed at the time of this writing. The cumulative seroreversion rate was 82.2%, 98.9% and 100% for TRUST at 0－3，4－6 and 7－9 months of age, respectively in 90 uninfected neonates, 3.1%, 30.2%, 85.4% and 100% for TPPA at 0－3，4－6, 7－9 and 10－12 months of age, respectively in 96 uninfected neonates. Of 16 neonates who missed some follow-up visits, all turned negative for TRUST and TPPA within 15 months after birth. As far as the TP-seropositive uninfected neonates were concerned, no statistical differences were observed in the seroreversion time of TRUST or TPPA between neonates receiving antisyphilitic treatment and those without antisyphilitic treatment （χ2 = 0.54, 2.41, respectively, both P ＞ 0.05）. The seroreversion of TRUST occurred earlier than that of TPPA （Z = 10.45, P < 0.01）. Conclusions Most uninfected neonates born to syphilitic mothers turn negative for TRUST within 6 months after birth, and for TPPA within 12 months. And the seroreversion of TRUST usually occurs earlier than that of TPPA. Antisyphilitic treatment shows no significant influence on the seroreversion time of TRUST or TPPA in these seropositive uninfected infants.

Key words: Syphilis serodiagnoses