妊娠梅毒192例临床分析

Clinical analysis of 192 pregnant women infected by syphilis

目的探讨妊娠梅毒患者的临床特点和影响妊娠结局的因素。方法192例经血清学检查确诊为梅毒的孕妇,根据妊娠期是否行全疗程抗梅毒治疗,分为治疗组(93例)及未治疗组(99例)。比较两组孕妇的妊娠结局、围产儿预后及新生儿先天梅毒的发生情况。同时根据母血清快速血浆反应素环状卡片试验(RPR)滴度高低,将192例梅毒孕妇分为≤1∶8组与≥1∶16组,观察血清滴度与妊娠结局的关系。结果(1)妊娠结局治疗组足月分娩率为936%(87/93),未治疗组仅为283%(28/99)。两组比较,差异有极显著性(P<001)。治疗组早产及死胎发生率分别为54%(5/93)和11%(1/93),明显低于未治疗组的283%(28/99)和323%(32/99),且治疗组无死产及流产发生。两组比较,差异有极显著性(P<0005)。治疗组分娩正常新生儿者占630%(58/92),未治疗组仅占232%(13/56)。治疗组窒息儿、低体重儿、先天梅毒患儿发生率及新生儿死亡率明显低于未治疗组,两组比较,差异有极显著性(P<001)。(2)RPR滴度≤1∶8组114例,≥1∶16组72例。≤1∶8组足月儿占781%(89/114),明显高于≥1∶16组的361%(26/72)。≤1∶8组早产儿、先天梅毒患儿、新生儿及围产儿死亡率,分别为53%(6/114)、219%(25/114)、26%(3/114)和193%(22/114),明显低于≥1∶16组的375%(27/72)、722%(52/72)。

Objective To investigate the clinical characteristics of pregnant women with syphilis, their pregnant outcomes, perinatal and neonatal prognosis and the incidence of congenital syphilis Methods One hundred and ninety two pregnant women with syphilis by serological assays were divided into two groups,group A( n =93): treated with a full course anti syphilis therapy and group B ( n =99): untreated group Meanwhile, they were divided into groups C and D according to maternal serum rapid plasma reagin (RPR)test: RPR titer ≤1∶8 (group C)and RPR titer ≥1∶16(group D) The pregnant outcomes and congenital syphilis were compared between two groups Results (1)Perinatal outcomes: Term delivery reached 93 6%(87/93)in group A and only 28 3%(28/99)in group B; the rate of premature birth and fetal intrauterine death were 5 4%(5/93)and 1 1%(1/93)in group A,obviously lower than 28 3% (28/99) and 32 3%(32/99)in group B ( P <0 005) No fetal intrauterine death and abortion occurred in the group A Prognosis of neonates: Normal neonates were 63 0%(58/92)in group A, and only 23 2%(13/56)in group B; the rates of asphyxia neonates, low birth weight, congenital syphilis and neonatal death in group A were significantly lower than those in group B( P <0 01) (2)The comparison between groups C and D: Term delivery rate in group C (78 1%,89/114)was higher than that in group D (36 1%,26/72);the rates of premature birth, congenital syphilis, perinatal death and neonatal death in group C were lower than those in group D ( P <0 01) (3) Gestational week and drug treatment: The earlier thetreatment started during pregnancy, the lower the rate of congenital syphilis was ( P <0 01) The incidences of congenital syphilis were similar between penicillin and dibenzyl penicillin groups( P <0 05). Conclusions (1) Effective full course anti syphilis therapy is the key to improving the outcomes of pregnancy with syphilis, prognosis of neonates and reducing incidence of congenital syphilis (2) Maternal serum RPR titer, the starting time of anti syphilis treatment as well as the choice of therapeutical drugs are important influence factors on the outcomes of pregnancy with syphilis