规范驱梅治疗后RPR持续阳性的梅毒孕妇154例临床分析

Clinical Analysis of 154 Pregnant Syphilitic Women with Persisting Positive RPR after Regular Anti-syphilis Treatment

目的探讨规范驱梅治疗后RPR持续阳性的孕妇是否需要终止妊娠和血清固定孕妇是否需要接受孕期驱梅治疗。方法按RPR持续阳性时间将154例梅毒孕妇分为3组，6个月～1年为I组。（1～2）年为Ⅱ组，2年以上为Ⅲ组（血清固定），进行回顾性分析。结果17例孕妇终止妊娠，继续妊娠孕妇分娩新生儿137例。所有新生儿经过随访，均未出现梅毒临床表现，RPR随访2年均可转阴，其中先天梅毒2例，出生时19s—IgM阳性1例，用苄星青霉素规范治疗后随访11月转阴；2年后随访TPPA仍阳性1例，用苄星青霉素规范治疗，现仍在随访中。10例低滴度血清固定孕妇，孕期未接受驱梅治疗，均成功分娩正常新生儿。结论规范驱梅治疗后RPR持续阳性梅毒孕妇可不终止妊娠，低滴度血清固定孕妇可以在密切监测的情况下不进行妊娠期内驱梅治疗。

Objective To investigate if the pregnant syphilitic women with persisting positive RPR should terminate their preg- nancy and if the pregnant women with low RPR titer sero - resistance should receive anti - syphilis treatment during their pregnancy. Methods The clinical data of 154 pregnant syphilitic women with persisting positive RPR were reviewed. Patients were divided into three groups according to the period of symptom persistence ： RPR,6 - 12 months （ group I ）, 13 - 24 months （group 2）,, more than 25 months （ group 3 ）. Results Seventeen of 154 pregnant women terminated their pregnancies. One hundred and thirty - seven infants did not have any clinical symptoms of syphilis and RPRs were negative, after two years follow - up . Two of the 137 infants had congenital syphilis; one was 19s -IgM positive, but treatment with penicillin was successful. The other was TPPA positive after two years of follow - up and also treated with penicillin. Ten pregnant women with low RPR titer sero - resistance, who did not receive anti - syphilis treatment during their pregnancies , had normal babies. Conclusion There is no evidence to suggest danger to the fetus among pregnancy woman with persisting positive RPR who have received regular anti - syphilis treat- ment. There is no clinical rationale for pregnant women with low RPR titer sero - resistance to receive anti - syphilis treatment during pregnancy.