妊娠期筛查和治疗梅毒的临床分析

Clinical analysis of the screening and therapy for syphilis during the pregnancy

目的探讨妊娠期筛查和治疗梅毒对妊娠结局的影响。方法采用前瞻性研究方法，根据筛查、诊断和治疗妊娠期梅毒的时机分为A、B、C三组，A组孕周≤16周；B组16周〈孕周≤28周；C组孕周〉28周，比较分析三组新生儿先天梅毒感染的情况。同时回顾性分析2003～2006年34例未治疗的妊娠期梅毒孕妇的资料，与治疗组比较不良妊娠结局的发生情况。结果筛查孕妇11679例，诊断妊娠期梅毒70例，其中Ⅰ期梅毒1例（1．43％），Ⅱ期梅毒2例（2．86％），余均为潜伏期梅毒67例（95．71％）。A、B、C三组新生儿先天梅毒感染分别是0例、3例和6例，感染率分别为0、11．11％和25．00％，三组新生儿先天梅毒感染率差异有统计学意义（P〈0．05）。比较治疗组与未治疗组的早产、新生儿梅毒感染、胎儿生长受限、先天梅毒儿、围生儿死亡等的发生率，差异有统计学意义（P〈0．05）。结论妊娠期梅毒的临床分期以潜伏期梅毒为主。孕期及时筛查和规范的抗梅毒治疗，能较好控制新生儿先天梅毒感染和不良妊娠结局的发生。

Objective To study the effect of screening and therapy for syphilis during the pregnancy. Methods The pregnancy women with syphilis were divided into three groups according to the time of screening, diagnosis and therapy： group A （the gestational age ≤16 weeks）, group B （16 weeks〈the gestational age≤28 weeks）, and group C （the gestational age〉28 weeks）. Using prospective study, to compare and analyze the infection status of congenital syphilis of the neonate. Meanwhile,34 eases of pregnancy women with syphilis untreated （from 2003 to 2006） were analyzed retrospectively,and compared the adverse pregnancy outcome with the treatment group. Results A total of 11 679 pregnancy women were screened for syphilis, and 70 eases were diagnosed with pregnancy syphilis,in which 1 ease of stage Ⅰ syphilis （1.43%）, 2 cases of stage Ⅱ syphilis （2.86%）, and 67 cases of latent syphilis （95.71%）. The case number of neonatal congenital syphilis of group A, B and C was 0, 3 and 6 respectively,and the infection rate was 0%, 11.11% and 25.00% respectively. It has statistical significance （P 〈 0.05）. The difference of the incidence of premature delivery,neonatal syphilis infection, FGR, congenital syphilis, and perinatal mortality rate between the group with therapy and that without therapy has statistical significance （P 〈 0.05）. Conclusion The clinical stage of syphilis during pregnancy is mainly latent syphilis. Screening for syphilis in time and normative anti-syphilis therapy during the pregnancy can control the incidence of the neonatal congenital infection and adverse pregnancy outcome.