摘要目的:分析梅毒相关婴儿胆汁淤积的临床表现。方法:本研究为回顾性研究，选取2017年1月至2021年8月西安市儿童医院感染三科收治的先天性梅毒同时合并婴儿胆汁淤积的20例患儿，男13例，女7例；年龄51(25，69)d，年龄范围为2~238 d，诊断明确后给予青霉素标准疗法驱梅治疗，对患儿的临床表现和辅助检查、治疗前后肝功能指标及随访情况进行分析。结果:通过对所有20例患儿进行分析，发现梅毒相关胆汁淤积常见的临床表现主要为转氨酶升高[100%(20/20)]、皮肤巩膜黄染[100%(20/20)]，其次为全身皮疹(皮肤红斑或斑丘疹)[65.0%(13/20)]，其余包括肝大[50.0%(10/20)]、鼻塞[45.0%(9/20)]，长骨平片提示骨膜反应[35.0%(7/20)]、干骺端透亮影及锯齿样变[30.0%(6/20)]，皮肤破溃[15.0%(3/20)]。治疗后总胆红素[66.5(33.7，77.8)μmol/L]、直接胆红素[21.5(10.3，46.4)μmol/L]、丙氨酸转氨酶[51.5(30.0，103.5)U/L]、天冬氨酸转氨酶[44.5(21.5，88.8)U/L]均低于治疗前[142.4(114.7，179.0)μmol/L、88.5(62.0，111.5)μmol/L、124.5(86.8，210.0)U/L、117.5(83.0，149.8)U/L]，差异均有统计学意义( P<0.05)。对所有患儿进行电话回访，除2例失访外其余18例患儿未再出现黄疸反复。 结论:梅毒相关婴儿胆汁淤积可表现为皮肤巩膜黄染、转氨酶升高、全身皮疹(皮肤红斑或斑丘疹)、皮肤破溃、肝大、鼻塞等，一旦明确诊断给予青霉素标准疗法驱梅治疗可有效改善预后。

abstractsObjective:To analyze the clinical manifestations of infantile cholestasis associated with syphilis.Methods:This study was a retrospective study, a total of 20 children with congenital syphilis and infantile cholestasis diagnosed in The Third department of Infectious Diseases of Xi′an Children′s Hospital from January 2017 to August 2021 were selected, including 13 males and 7 females; age 51(25, 69)d, the age range was 2 to 238 d. After the diagnosis was confirmed, they were given penicillin standard therapy to remove syphilis.The clinical manifestations, auxiliary examinations, liver function indexes before and after treatment, and follow-up were analyzed.Results:Through the analysis of all 20 children, it was found that the common clinical manifestations of syphilis-related cholestasis were elevated transaminases[100%(20/20)], yellow staining of skin and sclera[100%(20/20)], followed by systemic rash(skin erythema or maculopapular rash)[65.0%(13/20)]; the rest included hepatomegaly[50.0%(10/20)], nasal obstruction[45.0%(9/20)], and plain radiographs of long bones suggested periosteum Reaction[35.0%(7/20)], metaphyseal translucency, serrations[30.0%(6/20)]; skin ulceration[15.0%(3/20)]. After treatment, total bilirubin[66.5(33.7, 77.8)μmol/L], direct bilirubin[21.5(10.3, 46.4)μmol/L], alanine aminotransferase[51.5(30.0, 103.5)U/L], aspartate aminotransferase[44.5(21.5, 88.8)U/L]was lower than before treatment[142.4(114.7, 179.0)μmol/L, 88.5(62.0, 111.5)μmol/L, 124.5(86.8, 210.0)U/L]L, 117.5(83.0, 149.8)U/L], the difference was statistically significant( P<0.05). All the children were followed up by telephone, except for 2 patients who were lost to follow-up, the remaining 18 children did not have jaundice recurrence. Conclusions:Syphilitic infantile cholestasis can manifest as yellow discoloration of the skin and sclera, elevated transaminases, systemic rash(skin erythema or maculopapular rash), skin ulceration, hepatomegaly, nasal congestion, etc.Once the diagnosis is confirmed, standard penicillin therapy to remove syphilis is effective.