妊娠合并梅毒192例患者妊娠结局和子代随访研究
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摘要
目的探讨妊娠期合并梅毒螺旋体感染的患者在妊娠期间进行规范驱梅治疗对妊娠结局及新生儿血清学转归的影响。方法回顾性分析2009年1月至2014年2月在南京中医药大学附属南京医院妇产科收治的192例妊娠合并梅毒螺旋体感染孕妇的临床资料,所有患者经梅毒快速血浆反应试验(RPR)和梅毒螺旋体颗粒凝集试验(TPPA)筛查,根据孕妇孕期是否接受规范驱梅治疗,分为治疗组162例和未治疗组30例,对所有活产新生儿完成12个月的血清学RPR跟踪随访,比较妊娠期规范驱梅治疗对妊娠结局和分娩新生儿血清RPR转阴率的影响。结果治疗组与未治疗组孕母足月活产率(91.4%vs40.0%)、死胎死产率(0.6%vs 10.0%)、畸形引产率(1.2%vs 16.7%)、子代先天性梅毒率(0.6%vs 13.3%)组间比较差异均有统计学意义(P<0.05)。治疗组与未治疗组子代血清RPR累积转阴率在9个月(96.2%vs 75.0%)和12个月(97.4%vs 80.0%)差异均有统计学意义(P<0.01)。结论妊娠期梅毒螺旋体的筛查及规范驱梅治疗能显著降低妊娠不良结局的发生,降低子代感染先天梅毒的风险,其影响可持续至出生后12个月。
Objective To explore the impact of antisyphilitic treatment on pregnancy with syphilis and the transformation of rapid plasma regain(RPR)of the offspring.Methods In the total puerpera admitted in the hospital from January 2009 to February 2014,after screening with RPR of syphilis and treponema pallidum particle agglutination(TPPA),192 puerperal were recruited in the research and were separated into two groups-162 in the treated group and 30 in the untreated group. All live born neonates were followed up for 12 months and were retrospectively compared the effect of antisyphilitic treatment on the outcome of pregnancy and the rate of RPR negatively transformation of offspring.ResultsIn the treated group and the untreated group,the rate of term birth was91.4% vs 40.0%;the rate of fetal death/still births was 0.6% vs 10.0%;the rate of congenital malformation was 1.2% vs 16.7%;and the rate of congenital syphilis was 0.6% vs 13.3%;there were significant differences between the two groups(P<0.05).The rate of negative conversion in RPR of offspring at 6 months(96.2% vs 75.0%)and 9 months(97.4% vs 80.0%)after birth of the two groups were significantly different(P<0.01).Conclusion The syphilitic screening and antisyphilitic treatment during pregnancy could decrease the rate of harmful outcomes and neonatal infection of syphilis,which could ensure the quality of both maternal and neonatal health for 12 months.
Objective To explore the impact of antisyphilitic treatment on pregnancy with syphilis and the transformation of rapid plasma regain(RPR)of the offspring.Methods In the total puerpera admitted in the hospital from January 2009 to February 2014,after screening with RPR of syphilis and treponema pallidum particle agglutination(TPPA),192 puerperal were recruited in the research and were separated into two groups-162 in the treated group and 30 in the untreated group. All live born neonates were followed up for 12 months and were retrospectively compared the effect of antisyphilitic treatment on the outcome of pregnancy and the rate of RPR negatively transformation of offspring.ResultsIn the treated group and the untreated group,the rate of term birth was91.4% vs 40.0%;the rate of fetal death/still births was 0.6% vs 10.0%;the rate of congenital malformation was 1.2% vs 16.7%;and the rate of congenital syphilis was 0.6% vs 13.3%;there were significant differences between the two groups(P<0.05).The rate of negative conversion in RPR of offspring at 6 months(96.2% vs 75.0%)and 9 months(97.4% vs 80.0%)after birth of the two groups were significantly different(P<0.01).Conclusion The syphilitic screening and antisyphilitic treatment during pregnancy could decrease the rate of harmful outcomes and neonatal infection of syphilis,which could ensure the quality of both maternal and neonatal health for 12 months.
引文
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[6]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.
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[10]张荣莲,陈起燕,陈烈平,等.妊娠合并梅毒患者的母婴传播规律与干预方法[J].中华妇产科杂志,2007,42(7):438-442.
[11]郭红薇,姚小亚.驱梅治疗时机对妊娠合并梅毒患者妊娠结局、围产儿健康级先天性梅毒发生率的影响[J].临床医学研究与实践,2017,2(32):142-143.
[12]王吉,张海瑛,杨小兰.梅毒孕妇所产56例新生儿血清学随访结果分析[J].中国妇幼健康研究,2015,26(3):482-485.
[13]朱晓琴,王慧,谢艳.淮安市568例妊娠合并梅毒母儿结局分析[J].中国妇幼健康研究,2017,28(6):673-676.
[14]俞晓燕,徐海耿,周晓峰,等.梅毒螺旋体感染孕产妇所生新生儿127例随访分析[J].中华传染病杂志,2017,35(4):237-240.
[15]闫妙娥,王瑞莲,张华.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.
[16]吴佳聪,娄海琴.“三位一体”管理模式对梅毒母婴阻断效果的研究[J].东南国防医药,2017,19(5):519-521.
[2]王根菊,韩国荣,江红秀,等.妊娠梅毒RPR滴度对围产结局及新生儿血清学转归的影响[J].南京医科大学学报(自然科学版),2015,35(11):1624-1627.
[3]王翠敏,王根菊,韩国荣,等.妊娠合并梅毒192例妊娠结局分析[J].江苏医药,2015,41(10):1153-1155.
[4]刘冬先,徐昌敏,严小枫.妊娠梅毒58例流行特征及预后分析[J].中华医院感染学杂志,2009,19(8):926-929.
[5]蔡碧珊,郑道城,陈永锋.心理干预对复发性生殖器疱疹患者的心理健康状况的影响[J].国际医药卫生导报,2005,11(22):95-96.
[6]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.
[7] Qin JB,Feng TJ,Yang TB,et al.Risk factors for congenital syphilis and adverse pregnancy outcomes in offspring of women with syphilis in Shenzhen,China:a prospective nested case-control study[J].Sex Transm Dis,2014,41(1):13-23.
[8] Watson-Jones D,Changalucha J,Gumodoka B,et al.Syphilis in pregnancy in Tanzania.I.Impact of maternal syphilis on outcome of pregnancy[J].J Infect Dis,2002,18(6):940-947.
[9]李爱玲.头孢曲松钠与苄星青霉素治疗RPR高滴度妊娠合并梅毒的疗效[J].数理医药学杂志,2018,31(5):743-744.
[10]张荣莲,陈起燕,陈烈平,等.妊娠合并梅毒患者的母婴传播规律与干预方法[J].中华妇产科杂志,2007,42(7):438-442.
[11]郭红薇,姚小亚.驱梅治疗时机对妊娠合并梅毒患者妊娠结局、围产儿健康级先天性梅毒发生率的影响[J].临床医学研究与实践,2017,2(32):142-143.
[12]王吉,张海瑛,杨小兰.梅毒孕妇所产56例新生儿血清学随访结果分析[J].中国妇幼健康研究,2015,26(3):482-485.
[13]朱晓琴,王慧,谢艳.淮安市568例妊娠合并梅毒母儿结局分析[J].中国妇幼健康研究,2017,28(6):673-676.
[14]俞晓燕,徐海耿,周晓峰,等.梅毒螺旋体感染孕产妇所生新生儿127例随访分析[J].中华传染病杂志,2017,35(4):237-240.
[15]闫妙娥,王瑞莲,张华.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.
[16]吴佳聪,娄海琴.“三位一体”管理模式对梅毒母婴阻断效果的研究[J].东南国防医药,2017,19(5):519-521.