妊娠梅毒产妇胎儿宫内感染临床分析与超声特点
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摘要
目的探讨妊娠梅毒(Pregnant syphilis,PS)产妇胎儿宫内感染与超声特点。方法回顾性分析2015年1月-2017年5月医院收治的68例PS患者临床资料,根据胎儿宫内感染情况分为感染组25例和未感染组43例,比较两组患者临床特点(年龄、孕次、梅毒感染时间、治疗与否及胎儿结局)及不同时期超声影像表现。结果感染组梅毒感染时间<12周、12～28周、>28周分别为22例、3例、0例,检测出感染时间均早于未感染组(P<0.05);感染组治疗100.00%(25/25)高于未感染组(P<0.001);感染组胎儿死亡4例和先天性梅毒儿2例均多于未感染组3例和0例,但两组差异均无统计学意义;感染组前期胎囊不规则、胎盘水肿发生率分别为24.00%、24.00%均高于未感染组(P<0.05),后期宫内窘迫、肝肿大、全身水肿、腹水、脾肿大发生率分别为68.00%、88.00%、44.00%、60.00%、88.00%高于未感染组(P<0.001)。结论妊娠12周内多可检测到梅毒螺旋体,通过规范抗梅毒治疗能减少不良胎儿结局发生;超声影像表现对PS患者胎儿宫内感染情况可全面、直观反映,具有一定的临床价值。
OBJECTIVE To investigate fetal intrauterine infection in lying-in women with pregnant syphilis(PS)and the ultrasonic characteristics.METHODS The clinical data of 68 patients with PS diagnosed in the hospital from Jan.2015 to May 2017 were retrospectively analyzed.The patients were divided into the infected group(25 cases)and the uninfected group(43 cases)according to the occurrence of intrauterine infection.The clinical characteristics(age,gravidity,time of syphilis infection,treatment and fetal outcomes)and ultrasound imaging findings in different periods were compared between the two groups.RESULTS In the infected group,there were 22 cases,3 cases and 0 case with syphilis infection time shorter than 12 weeks,of 12-28 weeks and longer than 28 weeks,respectively,the detection of which were significantly earlier than the uninfected group(P<0.05).In the infected group,25 cases(100.00%)were treated,significantly more than uninfected group(P<0.001).21 fetuses survived,4 fetuses died and 2 fetuses had congenital syphilis in the infected group,whereas there were 3 cases of death and 0 case of congenital syphilis in the uninfected group.But there was no significant difference in fetal outcome between the two groups.The incidence rates of early fetal sac irregularity and placental edema in the infected group(24.00%,24.00%)were significantly higher than those in the control group(P<0.05).The incidence rates of fetal distress,hepatomegaly,anasarca,ascites and splenomegaly in the infected group in late stage(68.00%,88.00%,44.00%,60.00%,88.00%)were also significantly higher than those in the uninfected group(P<0.001).CONCLUSION Treponema pallidumcan be detected within 12 weeks of pregnancy.Standardized anti-syphilis treatment can significantly reduce the incidence of adverse fetal outcomes.Ultrasound imaging findings can comprehensively and intuitively reflect the status of intrauterine infection in patients with PS,and thus have certain clinical value.
OBJECTIVE To investigate fetal intrauterine infection in lying-in women with pregnant syphilis(PS)and the ultrasonic characteristics.METHODS The clinical data of 68 patients with PS diagnosed in the hospital from Jan.2015 to May 2017 were retrospectively analyzed.The patients were divided into the infected group(25 cases)and the uninfected group(43 cases)according to the occurrence of intrauterine infection.The clinical characteristics(age,gravidity,time of syphilis infection,treatment and fetal outcomes)and ultrasound imaging findings in different periods were compared between the two groups.RESULTS In the infected group,there were 22 cases,3 cases and 0 case with syphilis infection time shorter than 12 weeks,of 12-28 weeks and longer than 28 weeks,respectively,the detection of which were significantly earlier than the uninfected group(P<0.05).In the infected group,25 cases(100.00%)were treated,significantly more than uninfected group(P<0.001).21 fetuses survived,4 fetuses died and 2 fetuses had congenital syphilis in the infected group,whereas there were 3 cases of death and 0 case of congenital syphilis in the uninfected group.But there was no significant difference in fetal outcome between the two groups.The incidence rates of early fetal sac irregularity and placental edema in the infected group(24.00%,24.00%)were significantly higher than those in the control group(P<0.05).The incidence rates of fetal distress,hepatomegaly,anasarca,ascites and splenomegaly in the infected group in late stage(68.00%,88.00%,44.00%,60.00%,88.00%)were also significantly higher than those in the uninfected group(P<0.001).CONCLUSION Treponema pallidumcan be detected within 12 weeks of pregnancy.Standardized anti-syphilis treatment can significantly reduce the incidence of adverse fetal outcomes.Ultrasound imaging findings can comprehensively and intuitively reflect the status of intrauterine infection in patients with PS,and thus have certain clinical value.
引文
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[12]于妲,宗珍,俞波,等.妊娠期梅毒患者胎儿宫内感染的超声诊断研究[J].中国性科学,2016,25(8):115-117.
[13] Moline HR,Smith JF Jr.The continuing threat of syphilis in pregnancy[J].Curr Opin Obstet Gynecol,2016,28(2):101-104.
[14]连炬飞,黄瑞玉,刘紫菱,等.妊娠合并梅毒早期诊断及干预治疗对优生优育的临床意义[J].中国妇幼保健,2015,30(7):1048-1050.
[15]窦丽霞,王爱玲,王潇滟,等.妊娠合并梅毒孕妇的治疗及其不良妊娠结局的影响因素分析[J].中华妇产科杂志,2016,51(7):538-541.
[16] Dalle J,Ramos MC,Jimenez MF,et al.Oral desensitization to penicillin for the treatment of pregnant women with syphilis:a successful program[J].Rev Bras Ginecol Obstet,2018,40(1):43-46.
[17] Aga E,Keinan-Boker L,Eithan A,et al.Surgical site infections after abdominal surgery:incidence and risk factors.A prospective cohort study[J].Infect Dis,2015,47(11):761-767.
[18] Gomez GB,Kamb ML,Newman LM,et al.Untreated maternal syphilis and adverse outcomes of pregnancy:a systematic review and meta-analysis[J].Bull World Health Organ,2013,91(3):217-226.
[19]门杰,曾宁,张宇,等.孕期梅毒妇女胎儿宫内感染的超声影像研究[J].中华医院感染学杂志,2017,27(14):3285-3287.
[2] Moline HR,Smith JF Jr.The continuing threat of syphilis in pregnancy[J].Curr Opin Obstet Gynecol,2016,28(2):101-104.
[3] Mazzucchelli I,Decembrino L,Garofoli F,et al.Maternal and neonatal outcomes in pregnant women with autoimmune diseases in Pavia,Italy[J].BMC Pediatr,2015,15:217-225.
[4]闫妙娥,王瑞莲,张华,等.妊娠合并梅毒患者妊娠结局及围生儿梅毒感染情况分析[J].广东医学,2013,34(9):1415-1416.
[5]中华医学会妇产科学分会感染性疾病协作组.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(2):158-160.
[6]Amsalu A,Ferede G,Assegu D.High seroprevalence of syphilis infection among pregnant women in Yiregalem hospital southern Ethiopia[J].BMC Infect Dis,2018,18(1):109-121.
[7] Tian LS,Zhou GM,Yuan J,et al.Influencing factors analysis of pregnancy results in 318pregnant syphilis patients[J].China Trop Med,2016,16(2):149-151.
[8] Li Y,Zhu L,Du L,et al.Effects on preventing mother-tochild transmission of syphilis and associated adverse pregnant outcomes:a longitudinal study from 2001to 2015in Shanghai China[J].BMC Infect Dis,2017,17(1):626.
[9]肖雪,周燕媚,孙雯,等.2009~2013年妊娠合并梅毒孕妇及围产儿感染因素的调查[J].南方医科大学学报,2014,34(1):144-146.
[10] Tsimis ME,Sheffield JS.Update on syphilis and pregnancy[J].Birth Defects Res,2017,109(5):347-352.
[11] Blencowe H,Cousens S,Kamb M,et al.Lives saved tool supplement detection and treatment of syphilis in pregnancy to reduce syphilis related stillbirths and neonatal mortality[J].BMC Public Health,2011,11(Suppl 3):S9.
[12]于妲,宗珍,俞波,等.妊娠期梅毒患者胎儿宫内感染的超声诊断研究[J].中国性科学,2016,25(8):115-117.
[13] Moline HR,Smith JF Jr.The continuing threat of syphilis in pregnancy[J].Curr Opin Obstet Gynecol,2016,28(2):101-104.
[14]连炬飞,黄瑞玉,刘紫菱,等.妊娠合并梅毒早期诊断及干预治疗对优生优育的临床意义[J].中国妇幼保健,2015,30(7):1048-1050.
[15]窦丽霞,王爱玲,王潇滟,等.妊娠合并梅毒孕妇的治疗及其不良妊娠结局的影响因素分析[J].中华妇产科杂志,2016,51(7):538-541.
[16] Dalle J,Ramos MC,Jimenez MF,et al.Oral desensitization to penicillin for the treatment of pregnant women with syphilis:a successful program[J].Rev Bras Ginecol Obstet,2018,40(1):43-46.
[17] Aga E,Keinan-Boker L,Eithan A,et al.Surgical site infections after abdominal surgery:incidence and risk factors.A prospective cohort study[J].Infect Dis,2015,47(11):761-767.
[18] Gomez GB,Kamb ML,Newman LM,et al.Untreated maternal syphilis and adverse outcomes of pregnancy:a systematic review and meta-analysis[J].Bull World Health Organ,2013,91(3):217-226.
[19]门杰,曾宁,张宇,等.孕期梅毒妇女胎儿宫内感染的超声影像研究[J].中华医院感染学杂志,2017,27(14):3285-3287.