妊娠合并梅毒71例临床分析

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71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(39例)及未治疗组(32例)。比较两组孕妇的妊娠结局、围生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71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100%(39/39),未治疗组78%(25/32),两组比较,差异有极显著性(P<0.01)。治疗组分娩正常新生儿者占72%(28/39),未治疗组仅占25%(8/32),两组比较,差异有极显著性(P<0.01)。治疗组窒息儿、低体质量儿、先天梅毒患儿发生率及新生儿病死率均明显低于未治疗组,两组比较,差异有极显著性(P<0.01)。②RPR滴度:≤1:8组49例,≥1:16组22例。≤1:8组足月儿占98%(48/49),明显高于≥1:16组的73%(16/22)。≤1:8组早产儿、围生儿病死率均低于≥1:16组,两组比较,差异有极显著性(P<0.01),先天梅毒儿发病率两组比较,差异有显著性(P<0.05)。③治疗组孕妇中应用青霉素治疗者发生先天梅毒儿为26.0%(6/23),应用头孢曲松治疗者发生先天梅毒儿为21.4%(3/14),两组比较,差异无显著性(P>0.05)。另有2例孕妇服用红霉素治疗,所分娩的新生儿均为先天梅毒儿,发生率为100.0%,与其他两组先天梅毒儿发生率比较,差异有极显著性(P<0.01)。结论①有效的全程抗梅毒治疗是改善妊娠梅毒患者妊娠结局和围生儿预后,以及降低先天梅毒患儿发生率的关键。②母血清RPR滴度高低及用药,是影响妊娠梅毒结局的重要因素。

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 71 pregnant women with syphilis by serological assays were divided into two groups,group A（n=39）： treated with a full course anti-syphilis therapy and group B （n=32）： 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 100%（39/39） in group A and only 78%（25/32） in group B（P〈0.01）. Prognosis of neonates： Normal neonates were 72%（28/39） in group A, and only 25%（8/32） in group B; the rates of asphyxia neonates, low birth weight, congenital syphilis and neonatal death in group A were lower than those in group B（P〈0.01）.（2）The comparison between groups C and D： Term delivery rate in group C （98%,48/49） was higher than that in group D （73%,16/22）;the rates of premature birth, congenital syphilis, perinatal death in group C were lower than those in group D.（3） Drug treatment： The incidences of congenital syphilis were similar between penicillin and ceftriaxone 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 and the choice of therapeutical drugs are important influence factors on the outcomes of pregnancy with syphilis.