应用PCR产前诊断胎儿及孕妇梅毒感染的研究

Prenatal diagnosis of congenital syphilis by PCR and study on pregnant patients with syphilis.

目的:为了研究羊水聚合酶链反应(PCR)方法产前诊断胎儿先天梅毒以及梅毒对妊娠的影响,妊娠期梅毒的诊断治疗预后等问题。方法:对8例不同孕周患梅毒的孕妇抽取羊水用PCR方法检测梅毒螺旋体DNA;对22例患梅毒的孕妇应用青霉素或红霉素进行治疗并随访至分娩后;对261例因不良孕娩史而就诊妇女进行梅毒血清学检测并以无不良孕娩史普通妇科门诊病人111例作为对照。结果:8例羊水梅毒PCR检测结果6例阳性,2例阴性。其中1例阳性者终止妊娠,胎儿病理解剖证实有梅毒感染。22例梅毒孕妇经治疗3例失访,1例早产,18例足月分娩,新生儿临床及血清学检查均未见异常。因不良孕娩史而就诊妇女梅毒血清学阳性率(14.56%),明显高于无不良孕娩史的普通妇科门诊病人(5.40%)(P<0.01)。结论:羊水PCR梅毒DNA检测是诊断先天梅毒较好的方法,妊20周前胎儿可感染上梅毒。患梅毒的孕妇应早期足量正规治疗以防治胎儿感染。梅毒是导致不良孕娩史的重要原因。

Objective:In order to study prenatal diagnosis of congenital syphilis by polymerase chain reaction(PCR) using amniotic fluid and to investigate effects of syphilis on pregnancy,treatment and prognosis of pregnancy with syphilis.Methods:Amniocentesis and detect syphilis DNA by PCR were carried out on 8 pregnant syphilis patients;22 gravidas with syphilis were treated by penicillin and erythromycin.Follow-up evaluation was done after delivery.Serologic tests for syphilis were carried out on 261 women with abnormal pregnancy history,so did on 111 women without abnormal pregnancy history by contrast.Results:The results of PCR in six of the amniotic fluid specimens was positive,the other two PCR was negative.One pregnancy with positive PCR was terminated because of family.It is verified by autopsy that fetus infected by syphilis.After treating for 22 gravidas with syphilis,18 gravidas were on time labor,1 case was premature labor and 3 gravidas were lost to follow-up before delivery.All newborns had normal examinations without clinical or laboratory evidence of congenital infection.The quantitative TPHA in all newborns were less or equal to the maternal TPHA titres.The positive rate of serologic test for syphilis on women with abnormal pregnant history was 14.56%,otherwise positive rate on women without abnormal pregnant history was 5.40%,the former was significantly higher than the latter(χ2=9.89,P< 0.01).Conclusions:Detecting syphilis DNA of amniotic fluid by PCR is a good method for prenatal diagnosis of congenital syphilis.There was no correlation between of the maternal TPHA titre and in utero infections.in utero infections were found in the pregnancies less than 20 week′s gestation.In utero infections can be eradicated by maternal treatment,so gravidas with syphilis should betreated by sufficient antibiotic.Syphilis in an important cause leading to pregnancy loss.