先天性梅毒并发巨细胞病毒感染患儿的临床特征
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摘要
目的分析先天性梅毒并发巨细胞病毒感染患儿的临床特征。方法收集自2013年8月至2017年3月于首都医科大学附属北京地坛医院儿科住院的先天性梅毒患儿共128例,根据是否合并巨细胞病毒感染分为单纯先天性梅毒组(113例)和合并巨细胞病毒感染梅毒组(15例)。比较两组患儿的一般临床资料、有无肝脾肿大、肝功能损伤严重程度及持续时间、有无血液系统受累及肺部病变。结果两组患儿年龄和性别等一般临床资料差异无统计学意义(P均> 0.05)。15例并发巨细胞病毒感染的患儿中,2~12周者9例(60.0%),与常见巨细胞病毒感染年龄相符。113例单纯梅毒患儿中肝功能损伤者56例(49.6%),15例合并巨细胞病毒(CMV)感染的梅毒患儿中伴肝功能损伤者12例(80%)。单纯梅毒感染组与合并巨细胞病毒感染组患儿的血红蛋白(HGB)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)和总胆汁酸(TBA)水平差异均有统计学意义(P均<0.05);而两组患儿肺部病变、有无肝脾肿大、血小板减低(PLT)、总胆红素(TBil)、接胆红素(DBil)升高以及白蛋白(ALB)降低水平等差异无统计学意义(P均> 0.05)。结论合并巨细胞病毒感染的先天性梅毒患儿肝功能损伤及血液系统病变更严重,应早期诊断、早期治疗。
Objective To analyze the clinical characteristics of children of Congenital syphilis(CS) combined with cytomegalovirus(CMV) infection. Methods Total of 128 cases diagnosed as CS in Department of Pediatrics of Beijing Ditan Hospital, Capital Medical University from August 2013 to March 2017 were enrolled. The patients were divided into pure CS group(113 cases) and CS combined with CMV group(15 cases) according to whether or not with cytomegalovirus infection. The severity and duration of liver function damage, hepatosplenomegaly, blood system damage and lung infection were evaluated and compared between the two groups, respectively. Results General data, such as onset age or gender of patients in the two groups had no significant difference(all P > 0.05). Among the 15 CS patients complicated with CMV infection, 9 cases(60.0%) aged 2-12 weeks, similar to the pure CS patients. Among the 113 patients with pure CS, 56 cases(49.6%) had liver function damage, while 12 cases(80%) had liver function damage among the 15 cases of CS combined with CMV infection. The severity of liver function damage and blood system damage had significant difference of patients in the two groups(all P < 0.05). While there were no significant difference of lung infection, hepatosplenomegaly, thrombopenia, increased bilirubin and hypoalbuminemia between patients in the two groups. Conclusions CS patients combined with CMV infection had more serious liver function damage and blood system damage, who need early diagnosis and treatment.
Objective To analyze the clinical characteristics of children of Congenital syphilis(CS) combined with cytomegalovirus(CMV) infection. Methods Total of 128 cases diagnosed as CS in Department of Pediatrics of Beijing Ditan Hospital, Capital Medical University from August 2013 to March 2017 were enrolled. The patients were divided into pure CS group(113 cases) and CS combined with CMV group(15 cases) according to whether or not with cytomegalovirus infection. The severity and duration of liver function damage, hepatosplenomegaly, blood system damage and lung infection were evaluated and compared between the two groups, respectively. Results General data, such as onset age or gender of patients in the two groups had no significant difference(all P > 0.05). Among the 15 CS patients complicated with CMV infection, 9 cases(60.0%) aged 2-12 weeks, similar to the pure CS patients. Among the 113 patients with pure CS, 56 cases(49.6%) had liver function damage, while 12 cases(80%) had liver function damage among the 15 cases of CS combined with CMV infection. The severity of liver function damage and blood system damage had significant difference of patients in the two groups(all P < 0.05). While there were no significant difference of lung infection, hepatosplenomegaly, thrombopenia, increased bilirubin and hypoalbuminemia between patients in the two groups. Conclusions CS patients combined with CMV infection had more serious liver function damage and blood system damage, who need early diagnosis and treatment.
引文
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[11]Zhang X,Zhang T,Pei J,et al.Time series modelling of s y p h i l i s i n c i d e n c e i n C h i n a f r o m 2 0 0 5 t o 2 0 1 2[J].P L o SOne,2016,11(2):e0149401.
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[13]樊尚荣.妊娠合并梅毒的诊断和处理专家共识[J].中华妇产科杂志,2012(47):158-160.
[14]崔静.1 8 3例先天性梅毒临床资料分析[D].吉林:吉林大学,2012:11,22.
[15]胡旭红,杜逸婷,罗晓红.72例新生儿早期先天性梅毒临床分析[J].传染病信息,2014,27(3):173-175.
[16]Kang SH,Lee JH,Choi SH,et al.Recent change in congenital syphilis in Korea:retrospective 10 year study[J].Pediatr Int,2015,57(6):1112-1115.
[17]Sanchez-Gomez A,Cevallos W,Grijalva MJ,et al.Social factors associated with use of prenatal care in Ecuador[J].Rev Panam Salud Publica,2016,40(5):341-346.
[18]Pinninti SG,Rodgers MD,Novak Z,et al.Clinical predictors of sensorineural hearing loss and cognitive outcome in infants with symptomatic congeni tal cytomegalovirus infection[J].Pediatr Infect Dis J,2016,35(8):924-926.
[19]Brecht KF,Goelz R,Bevot A,et al.Postnatal human cytomegalovirus infection in preterm infants has long-term neuropsychological sequelae[J].J Pediatr,2015,166(4):834-839.
[20]De Lonlay-Debeney P,von Kleist-Retzow JC,Hertz-Pannier L,et al.Cerebral white matter disease in children may be caused by mitochondrial respiratory chain deficiency[J].J Pediatr,2000,136(2):209-214.
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[22]徐玉敏,朱雪萍,肖志辉,等.婴幼儿巨细胞病毒感染138例临床及治疗观察[J].东南大学学报(医学版),2013,32(5):587-590.
[23]袁慧,高源.婴幼儿1 200例巨细胞病毒感染临床分析[J].中国妇幼保健,2016,31(5):981-982.
[24]James SH,Hartline C,Kimberlin DW,et al.Genotypic resistance testing in infants with congenital cytomegalovirus disease receiving long-term oral valganciclovir therapy[C].Open Forum Infectious Diseases.Oxford University Press,2015,2(Suppl 1):476.
[25]崔京涛,马良坤,倪安平,等.2008至2015年育龄妇女及新生儿TORCH血清学筛查及临床意义分析[J].中华检验医学杂志,2016,39(4):281-285.
[26]万方锐,张江华,吴凡,等.56例婴儿巨细胞病毒感染临床分析[J].当代医学,2014,20(19):100-101.
[27]蒋卡丽,曹清勇,温勇晖,等.新生儿巨细胞病毒感染的临床特点分析[J].现代诊断与治疗,2016,27(18):3491-3493.
[28]Goedhals D,Kriel J,Hertzog ML,et al.Human cytomegalovirus infection in infants with prolonged neonatal jaundice[J].J Clin Virol,2008,43(2):216-218.
[29]Azam AZ,Vial Y,Fawer CL,et al.Prenatal diagnosis of congenital cytomegalo virus infection[J].Obstet Gynecol,2001,97(3):443-448.
[30]陈斌,何国产.常见性病患者巨细胞病毒感染461例分析[J].浙江实用医学,2002,7(4):239-240.
[31]Chen ZQ,Zhang GC,Gong XD,et al.Syphilis in china:results of a nation surveillance programme[J].Lancet,2007,369(9556):132-138.
[2]Mc Clean H,Carne CA,Sullivan AK,et al.Chlamydial partner notification in the British Association for Sexual Health and HIV(BASHH)2011 UK national audit against the BASHHMedical Foundation for AIDS and Sexual Health Sexually Transmitted Infections Management Standards[J].Int J STDAIDS,2012,23(10):748-752.
[3]王小永,魏艳.新生儿先天性梅毒3 6例临床分析[J].四川医学,2013,34(1):137-139.
[4]Workowski KA,Berman S,Centers for Disease Control and Prevention(CDC).Sexually transmitted diseases treatment guidelines,2010[J].MMWR Recomm Rep,2010,17,59(RR-12):1-110.
[5]中华人民共和国卫生部.梅毒诊断标准(WS268-2007)[S].北京:人民卫生出版社,2007.
[6]方峰.巨细胞病毒诊断方案[J].中华儿科杂志,1999,7(33):441.
[7]中华医学会外科学会.门静脉高压症肝功能分级试行标准[J].中华外科杂志,1983,21:433.
[8]樊尚荣,梁丽芬.2 0 1 5年美国疾病控制中心性传播疾病诊断和治疗指南(续)--梅毒的诊断和治疗指南[J].中国全科医学,2015,18(27):3260-3264.
[9]庞琳,曾慧慧,何明.妊娠合并梅毒孕期规范治疗后新生儿梅毒血清学的变化特点及转归[J].中国围产医学杂志,2010,13(4):282-285.
[10]张学军主编.皮肤性病学[M].北京:人民卫生出版社,2013:221-223.
[11]Zhang X,Zhang T,Pei J,et al.Time series modelling of s y p h i l i s i n c i d e n c e i n C h i n a f r o m 2 0 0 5 t o 2 0 1 2[J].P L o SOne,2016,11(2):e0149401.
[12]吴小明,张美珍,姜新华,等.不同检测方法对新生儿期先天性梅毒的诊断价值比较研究[J].中国性科学,2013,22(10):65-68.
[13]樊尚荣.妊娠合并梅毒的诊断和处理专家共识[J].中华妇产科杂志,2012(47):158-160.
[14]崔静.1 8 3例先天性梅毒临床资料分析[D].吉林:吉林大学,2012:11,22.
[15]胡旭红,杜逸婷,罗晓红.72例新生儿早期先天性梅毒临床分析[J].传染病信息,2014,27(3):173-175.
[16]Kang SH,Lee JH,Choi SH,et al.Recent change in congenital syphilis in Korea:retrospective 10 year study[J].Pediatr Int,2015,57(6):1112-1115.
[17]Sanchez-Gomez A,Cevallos W,Grijalva MJ,et al.Social factors associated with use of prenatal care in Ecuador[J].Rev Panam Salud Publica,2016,40(5):341-346.
[18]Pinninti SG,Rodgers MD,Novak Z,et al.Clinical predictors of sensorineural hearing loss and cognitive outcome in infants with symptomatic congeni tal cytomegalovirus infection[J].Pediatr Infect Dis J,2016,35(8):924-926.
[19]Brecht KF,Goelz R,Bevot A,et al.Postnatal human cytomegalovirus infection in preterm infants has long-term neuropsychological sequelae[J].J Pediatr,2015,166(4):834-839.
[20]De Lonlay-Debeney P,von Kleist-Retzow JC,Hertz-Pannier L,et al.Cerebral white matter disease in children may be caused by mitochondrial respiratory chain deficiency[J].J Pediatr,2000,136(2):209-214.
[21]覃小梅,曾显媛,秦丽容.小儿巨细胞病毒感染59例临床分析[J].实用医技杂志,2011,18(3):287-288.
[22]徐玉敏,朱雪萍,肖志辉,等.婴幼儿巨细胞病毒感染138例临床及治疗观察[J].东南大学学报(医学版),2013,32(5):587-590.
[23]袁慧,高源.婴幼儿1 200例巨细胞病毒感染临床分析[J].中国妇幼保健,2016,31(5):981-982.
[24]James SH,Hartline C,Kimberlin DW,et al.Genotypic resistance testing in infants with congenital cytomegalovirus disease receiving long-term oral valganciclovir therapy[C].Open Forum Infectious Diseases.Oxford University Press,2015,2(Suppl 1):476.
[25]崔京涛,马良坤,倪安平,等.2008至2015年育龄妇女及新生儿TORCH血清学筛查及临床意义分析[J].中华检验医学杂志,2016,39(4):281-285.
[26]万方锐,张江华,吴凡,等.56例婴儿巨细胞病毒感染临床分析[J].当代医学,2014,20(19):100-101.
[27]蒋卡丽,曹清勇,温勇晖,等.新生儿巨细胞病毒感染的临床特点分析[J].现代诊断与治疗,2016,27(18):3491-3493.
[28]Goedhals D,Kriel J,Hertzog ML,et al.Human cytomegalovirus infection in infants with prolonged neonatal jaundice[J].J Clin Virol,2008,43(2):216-218.
[29]Azam AZ,Vial Y,Fawer CL,et al.Prenatal diagnosis of congenital cytomegalo virus infection[J].Obstet Gynecol,2001,97(3):443-448.
[30]陈斌,何国产.常见性病患者巨细胞病毒感染461例分析[J].浙江实用医学,2002,7(4):239-240.
[31]Chen ZQ,Zhang GC,Gong XD,et al.Syphilis in china:results of a nation surveillance programme[J].Lancet,2007,369(9556):132-138.