妊娠梅毒的孕期干预时机对妊娠结局的影响研究
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摘要
目的:分析并探讨妊娠梅毒孕妇孕期干预时机对母婴妊娠结局的影响。方法:选取医院进行产检及分娩的孕妇254例,所有孕期发现梅毒后,均给予长效青霉素治疗。早期干预组给予240万U,臀部肌内注射,1次/周,3周/疗程。每疗程结束后复查,若转阴,则晚期再治疗1个疗程,若未转阴且RPR(快速血浆反应素环状卡片试验)滴度下降小于2倍比稀释度,则继续治疗1个疗程。对于中期干预者,在发现后治疗1个疗程,晚期治疗1个疗程。晚期干预者在发现后即治疗1个疗程。结果:早期干预组早产、低体重儿12例(10.00%),死胎0例,新生儿畸形0例,新生儿死亡0例,新生儿梅毒0例;中期干预组早产、低体重儿22例(26.83%),死胎2例(2.44%),新生儿畸形2例(2.44%),新生儿死亡0例,新生儿梅毒2例(2.44%);晚期干预组早产、低体重儿26例(50.00%),死胎8例(15.38%),新生儿畸形4例(7.69%),新生儿死亡4例(7.69%),新生儿梅毒10例(19.23%)。早期干预妊娠结局最优,且新生儿梅毒发生率最低(P<0.05)。RPR滴度低组,妊娠结局明显优于滴度高组,且新生儿梅毒发生率低(P<0.05)。结论:妊娠梅毒孕妇孕期早期干预有利于改善妊娠结局,降低新生儿先天梅毒发生率,临床上对疑似孕妇应尽早诊治。
Objectives: To analyze and discuss the effect of intervention timing for pregnancy outcomes of syphilis in pregnancy. Methods: 254 pregnant women treated in our hospital were selected. Pregnancy women who were found with syphilis were given long-acting penicillin treatment. Early intervention group received 2. 4 million U buttocks intramuscular injection,once a week,3 weeks per course. Reexamination was done after each course of treatment. If the result was negative,the patients received an additional course of treatment in late pregnancy. If the result was not negative and RPR( rapid plasma reagin test) titers decreased less than 2 times of dilution,the patients received an additional course of treatment. For mid-intervention group,the patients received a course of treatment while discovering the disease,and an additional course of treatment in late pregnancy. For late-intervention group,the patients received a course of treatment while discovering the disease. Results: In early intervention group,there were 12 cases of premature birth and low birth weight children( 10. 00%),0 case of stillbirth,0 case of neonatal malformations,0 case of neonatal death and 0 case of neonatal syphilis. In mid-intervention group,there were 22 cases of premature birth and low birth weight children( 26. 83%),2 cases of stillbirth( 2. 44%),2cases of neonatal malformation( 2. 44%),0 case of neonatal deaths and 2 cases of neonatal syphilis( 2. 44%). In late intervention group,there were 26 cases of premature delivery and low birth weight children( 50. 00 %),8 cases of stillbirth( 15. 38%),4 cases of neonatal malformations( 7. 69%),4 cases of neonatal death( 7. 69%) and10 cases of neonatal syphilis( 19. 23%). Pregnancy outcomes of early intervention group was the best and neonatal syphilis incidence was the lowest( P < 0. 05). Pregnancy outcomes of low RPR titer group was significantly better than that of high titer group as well as the incidence of neonatal syphilis( P < 0. 05). Conclusion: Early intervention of pregnancy syphilis helps improve pregnancy outcomes,reduce the incidence of neonatal congenital syphilis.Pregnant women with suspected syphilis infection should be early diagnosed and treated.
Objectives: To analyze and discuss the effect of intervention timing for pregnancy outcomes of syphilis in pregnancy. Methods: 254 pregnant women treated in our hospital were selected. Pregnancy women who were found with syphilis were given long-acting penicillin treatment. Early intervention group received 2. 4 million U buttocks intramuscular injection,once a week,3 weeks per course. Reexamination was done after each course of treatment. If the result was negative,the patients received an additional course of treatment in late pregnancy. If the result was not negative and RPR( rapid plasma reagin test) titers decreased less than 2 times of dilution,the patients received an additional course of treatment. For mid-intervention group,the patients received a course of treatment while discovering the disease,and an additional course of treatment in late pregnancy. For late-intervention group,the patients received a course of treatment while discovering the disease. Results: In early intervention group,there were 12 cases of premature birth and low birth weight children( 10. 00%),0 case of stillbirth,0 case of neonatal malformations,0 case of neonatal death and 0 case of neonatal syphilis. In mid-intervention group,there were 22 cases of premature birth and low birth weight children( 26. 83%),2 cases of stillbirth( 2. 44%),2cases of neonatal malformation( 2. 44%),0 case of neonatal deaths and 2 cases of neonatal syphilis( 2. 44%). In late intervention group,there were 26 cases of premature delivery and low birth weight children( 50. 00 %),8 cases of stillbirth( 15. 38%),4 cases of neonatal malformations( 7. 69%),4 cases of neonatal death( 7. 69%) and10 cases of neonatal syphilis( 19. 23%). Pregnancy outcomes of early intervention group was the best and neonatal syphilis incidence was the lowest( P < 0. 05). Pregnancy outcomes of low RPR titer group was significantly better than that of high titer group as well as the incidence of neonatal syphilis( P < 0. 05). Conclusion: Early intervention of pregnancy syphilis helps improve pregnancy outcomes,reduce the incidence of neonatal congenital syphilis.Pregnant women with suspected syphilis infection should be early diagnosed and treated.
引文
[1]丁晓颖,黄鹰,杨伶俐,等.妊娠合并隐性梅毒265例不良妊娠结局分析.中国热带医学,2014,14(4):451-454.
[2]吴炜英,裘桂静,俞旦旦,等.妊娠期梅毒早期母婴阻断效果分析.国际流行病学传染病学杂志,2014,41(2):101-103.
[3]许卫华.产前抗梅毒治疗对妊娠梅毒患者妊娠结局及新生儿预后的影响.中外医学研究,2014,12(14):9-10,11.
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[5]周敏,陈竹,曾义岚,等.抗梅毒治疗对妊娠结局及新生儿预后的影响.中华临床感染病杂志,2013,6(4):226-229.
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[7]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.南方医科大学学报,2014,34(1):144-146.
[8]Owusu-Edusei K,Tao G,Gift TL,et al.Cost-effectiveness of integrated routine offering of prenatal HIV and syphilis screening in China.Sexually Transmitted Diseases,2014,41(2):103-110.
[9]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.中国妇幼保健,2015,30(7):1048-1050.
[10]黄海霞,祝昭惠,周敏,等.490例妊娠梅毒母婴妊娠结局的病例对照研究.四川医学,2013,34(7):963-965.
[11]魏红,陈竹,曾义岚,等.抗梅毒治疗对妊娠梅毒预后的影响分析.中华实验和临床感染病杂志(电子版),2013,7(4):571-573.
[12]陈璇.驱梅治疗时机对妊娠合并梅毒孕妇妊娠结局的影响.贵阳医学院学报,2014,39(6):930-932.
[13]王翠敏,王根菊,韩国荣,等.妊娠合并梅毒192例妊娠结局分析.江苏医药,2015,41(10):1153-1155.
[14]闫宁,陈斌,蒋辉丽,等.快速血浆反应素高滴度的116例妊娠梅毒患者治疗后的妊娠结局.临床皮肤科杂志,2014,43(12):710-712.
[15]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.广东医学,2013,34(9):1415-1416.
[16]Bonawitz RE,Duncan J,Hammond E,et al.Assessment of the impact of rapid syphilis tests on syphilis screening and treatment of pregnant women in Zambia.International Journal of Gynecology&Obstetrics,2015(130):S58-S62.
[17]Mmeje O,Chow JM,Davidson L,et al.Discordant syphilis immunoassays in pregnancy:Perinatal outcomes and implications for clinical management.Clinical Infectious Diseases,2015,61(7):1049-1053.
[18]Lawi JDT,Mirambo MM,Magoma M,et al.Sero-conversion rate of Syphilis and HIV among pregnant women attending antenatal clinic in Tanzania:a need for re-screening at delivery.BMC Pregnancy and Childbirth,2015,15(1):3.
[2]吴炜英,裘桂静,俞旦旦,等.妊娠期梅毒早期母婴阻断效果分析.国际流行病学传染病学杂志,2014,41(2):101-103.
[3]许卫华.产前抗梅毒治疗对妊娠梅毒患者妊娠结局及新生儿预后的影响.中外医学研究,2014,12(14):9-10,11.
[4]Krakauer Y,Pariente G,Sergienko R,et al.Perinatal outcome in cases of latent syphilis during pregnancy.International Journal of Gynecology and Obstetrics,2012,118(1):15-17.
[5]周敏,陈竹,曾义岚,等.抗梅毒治疗对妊娠结局及新生儿预后的影响.中华临床感染病杂志,2013,6(4):226-229.
[6]Asundep NN,Jolly PE,Carson A,et al.Antenatal care attendance,a surrogate for pregnancy outcome the case of kumasi,Ghana.Maternal and Child Health Journal,2014,18(5):1085-1094.
[7]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.南方医科大学学报,2014,34(1):144-146.
[8]Owusu-Edusei K,Tao G,Gift TL,et al.Cost-effectiveness of integrated routine offering of prenatal HIV and syphilis screening in China.Sexually Transmitted Diseases,2014,41(2):103-110.
[9]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.中国妇幼保健,2015,30(7):1048-1050.
[10]黄海霞,祝昭惠,周敏,等.490例妊娠梅毒母婴妊娠结局的病例对照研究.四川医学,2013,34(7):963-965.
[11]魏红,陈竹,曾义岚,等.抗梅毒治疗对妊娠梅毒预后的影响分析.中华实验和临床感染病杂志(电子版),2013,7(4):571-573.
[12]陈璇.驱梅治疗时机对妊娠合并梅毒孕妇妊娠结局的影响.贵阳医学院学报,2014,39(6):930-932.
[13]王翠敏,王根菊,韩国荣,等.妊娠合并梅毒192例妊娠结局分析.江苏医药,2015,41(10):1153-1155.
[14]闫宁,陈斌,蒋辉丽,等.快速血浆反应素高滴度的116例妊娠梅毒患者治疗后的妊娠结局.临床皮肤科杂志,2014,43(12):710-712.
[15]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.广东医学,2013,34(9):1415-1416.
[16]Bonawitz RE,Duncan J,Hammond E,et al.Assessment of the impact of rapid syphilis tests on syphilis screening and treatment of pregnant women in Zambia.International Journal of Gynecology&Obstetrics,2015(130):S58-S62.
[17]Mmeje O,Chow JM,Davidson L,et al.Discordant syphilis immunoassays in pregnancy:Perinatal outcomes and implications for clinical management.Clinical Infectious Diseases,2015,61(7):1049-1053.
[18]Lawi JDT,Mirambo MM,Magoma M,et al.Sero-conversion rate of Syphilis and HIV among pregnant women attending antenatal clinic in Tanzania:a need for re-screening at delivery.BMC Pregnancy and Childbirth,2015,15(1):3.