郑州市医疗机构梅毒母婴阻断效果影响因素分析
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摘要
目的:分析影响梅毒母婴阻断效果的相关因素,为开展综合干预服务提供科学依据。方法:回顾性分析2015年1月—2017年12月在郑州市医疗机构接受梅毒母婴阻断治疗或分娩的妊娠期梅毒患者278例临床资料。结果:278例梅毒孕产妇中,流产2例,早产10例,死产9例,新生儿中,死亡2例,先天梅毒19例,正常儿236例,梅毒母婴阻断成功率为84. 9%。文化程度、职业、不良妊娠史、孕妇梅毒RPR滴度、干预时机、梅毒知识知晓情况等均与梅毒母婴阻断失败相关(χ~2值=6.162、16.581、3.493、6.360、6.029、4.503,均P<0.05);logistic多因素分析显示,高中及以上文化程度是影响梅毒母婴阻断效果的保护因素,服务业、其他行业、不良妊娠史、孕妇梅毒RPR滴度及干预时机是影响梅毒母婴阻断效果的独立危险因素(OR值=0.237、1.672、1.406、2.815、3.114、4.797,均P<0.05)。结论:对影响梅毒母婴阻断效果的危险因素采取针对性阻断措施,是提高梅毒母婴阻断效果有效办法。
Objective: To analyze the related factors affecting the efficacy of maternal-infant blocking of syphilis, and to provide scientific evidence for the comprehensive intervention service for prevention of syphilis mother-to-child transmission. Methods: The clinical data of 278 women with syphilis during pregnancy from January 2015 to December 2017 in Zhengzhou City were analyzed retrospectively. Results: Among 278 pregnant women with syphilis, there were 2 cases of abortion, 10 cases of premature delivery, 9 cases of stillbirth, 2 cases of neonatal death, 19 cases of congenital syphilis of newborns, and 236 cases of normal children. The success rate of syphilis mother-infant block was 84.9%. The educational level, occupation, history of adverse pregnancy, RPR titer of pregnant women's syphilis, timing of intervention, and knowledge of syphilis were significantly correlated with the efficacy of maternal-infant blockade of syphilis(χ~2=6.162, 16.581, 3.493, 6.360, 6.029, or 4.503, both P<0.05). Logistic multivariate analysis showed that high school education and above was the protective factors of maternal-infant blockade of syphilis. Women in service or other industry, adverse pregnancy history, syphilis RPR titer of pregnant women, and intervention timing were independent risk factors of maternal-infant blockade of syphilis(OR=0.237, 1.672, 1.406, 2.815, 3.114, 4.797, both P<0.05). Conclusion: Targeted measures for the independent risk factors of maternal-infant blockade of syphilis can improve the efficacy of maternal-infant blockade of syphilis.
Objective: To analyze the related factors affecting the efficacy of maternal-infant blocking of syphilis, and to provide scientific evidence for the comprehensive intervention service for prevention of syphilis mother-to-child transmission. Methods: The clinical data of 278 women with syphilis during pregnancy from January 2015 to December 2017 in Zhengzhou City were analyzed retrospectively. Results: Among 278 pregnant women with syphilis, there were 2 cases of abortion, 10 cases of premature delivery, 9 cases of stillbirth, 2 cases of neonatal death, 19 cases of congenital syphilis of newborns, and 236 cases of normal children. The success rate of syphilis mother-infant block was 84.9%. The educational level, occupation, history of adverse pregnancy, RPR titer of pregnant women's syphilis, timing of intervention, and knowledge of syphilis were significantly correlated with the efficacy of maternal-infant blockade of syphilis(χ~2=6.162, 16.581, 3.493, 6.360, 6.029, or 4.503, both P<0.05). Logistic multivariate analysis showed that high school education and above was the protective factors of maternal-infant blockade of syphilis. Women in service or other industry, adverse pregnancy history, syphilis RPR titer of pregnant women, and intervention timing were independent risk factors of maternal-infant blockade of syphilis(OR=0.237, 1.672, 1.406, 2.815, 3.114, 4.797, both P<0.05). Conclusion: Targeted measures for the independent risk factors of maternal-infant blockade of syphilis can improve the efficacy of maternal-infant blockade of syphilis.
引文
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[12] 卢江炜,汤雪娟,张晓辉,等.综合干预妊娠合并梅毒的调查研究[J].中国妇幼健康研究,2016,27(08):1006-1008.
[13] 许宗严,邱莉霞,李频,等.妊娠梅毒患者772例母婴梅毒传播阻断效果回顾性分析[J].中国皮肤性病学杂志,2012,26(08):720-722.
[14] 许玉军,朱考考,廖正发,等.海南省新生儿先天梅毒危险因素研究[J].中国热带医学,2018,18(10):1064-1066.
[15] 郑玉,朱焱,辛丽梅,等.贵州省农村育龄妇女不良妊娠结局现状及影响因素分析[J].现代预防医学,2018,45(02):247-250+258.
[16] Creegan L, Bauer HM, Samuel MC, et al. An evaluation of the relative sensitivities of the venereal disease research laboratory test and the Treponema pallidum particle agglutination test among patients diagnosed with primary syphilis[J]. Sex Transm Dis,2007,34 (12):1016-1018.
[17] 曹羽明,曹越,杜二球,等.不同干预时机对妊娠期梅毒母儿结局的影响[J].中国生育健康杂志,2017,28(3):266-272.
[18] 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,2011,13(3) : S9.
[19] Domingues RM,Szwarcwald CL,Souza Junior PR,et aI.Prevalence of syphilis in pregnancy and prenatal syphilis testing in Brazil: birth in Brazil study.2014,48(5)766-774.
[2] 张万宏,徐业华,石卫东,等.2010-2015年武汉市梅毒网络报告发病率与人群估计感染率对比分析[J].实用预防医学,2018,25(10):1184-1186.
[3] Zammarchi L,Borchi B,Chiappini E,et al. Syphilis in pregnancy in Tuscany,description of a case series from a global health perspective[J]. J Matern Fetal Neonatal Med,2012,25(12):2601-2605.
[4] 李晓,李瑞琼,杜晓琴,等.产前抗梅毒治疗对妊娠期梅毒患者妊娠结局影响的临床研究[J]. 中国性科学.2016,25(1):74-78.
[5] 王慧玲,范淑静,程占莲,等.妊娠期梅毒的临床特点及妊娠结局分析[J].医学综述,2014,20 (1):176-178.
[6] 顾逢春,凌静,朱玉莲,等.2014-2015年江阴市妊娠梅毒流行特征及新生儿结局[J].中国妇幼健康研究,2017,28(2):114-117.
[7] 祝朝萍.妊娠期梅毒临床结局的相关因素分析及临床诊治[J].中国性科学,2013,22 (9): 31-34.
[8] 谢幸,苟文丽.妇产科学·第八版[M].2013:102-103.
[9] Bristow CC,Larson E,Anderson LJ,et al. Cost-effectiveness of HIV and syphilis antenatal screening: a modelling study [J].Sex Transm Infect,2016,92 (5): 340-346.
[10] Taylor M,Gliddon H,Nurse-Findlay S,et al. Revisiting strategies to eliminate mother-to-child transmission of syphilis [J].Lancet Global Health,2018,6 (1): 26-28.
[11] 中华人民共和国卫生部.中国预防与控制梅毒规划(2010—2020年)[Z]2010.
[12] 卢江炜,汤雪娟,张晓辉,等.综合干预妊娠合并梅毒的调查研究[J].中国妇幼健康研究,2016,27(08):1006-1008.
[13] 许宗严,邱莉霞,李频,等.妊娠梅毒患者772例母婴梅毒传播阻断效果回顾性分析[J].中国皮肤性病学杂志,2012,26(08):720-722.
[14] 许玉军,朱考考,廖正发,等.海南省新生儿先天梅毒危险因素研究[J].中国热带医学,2018,18(10):1064-1066.
[15] 郑玉,朱焱,辛丽梅,等.贵州省农村育龄妇女不良妊娠结局现状及影响因素分析[J].现代预防医学,2018,45(02):247-250+258.
[16] Creegan L, Bauer HM, Samuel MC, et al. An evaluation of the relative sensitivities of the venereal disease research laboratory test and the Treponema pallidum particle agglutination test among patients diagnosed with primary syphilis[J]. Sex Transm Dis,2007,34 (12):1016-1018.
[17] 曹羽明,曹越,杜二球,等.不同干预时机对妊娠期梅毒母儿结局的影响[J].中国生育健康杂志,2017,28(3):266-272.
[18] 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,2011,13(3) : S9.
[19] Domingues RM,Szwarcwald CL,Souza Junior PR,et aI.Prevalence of syphilis in pregnancy and prenatal syphilis testing in Brazil: birth in Brazil study.2014,48(5)766-774.