妊娠梅毒的孕期干预时机对妊娠结局的影响分析

Effect of intervention time on pregnancy outcomes among pregnant women with syphilis

目的探讨妊娠梅毒患者的不同干预治疗时机,对妊娠结局及新生儿先天梅毒的影响。方法收集2008年1月至2012年12月收治的妊娠梅毒孕妇,回顾性分析和比较不同干预治疗时机对妊娠梅毒患者的不良妊娠结局及新生儿先天梅毒的发生率。采用SPSS 11.5进行数据的统计分析。结果共调查妊娠梅毒孕妇127例,妊娠梅毒均经血清学检查确诊。根据患者孕期实施干预(长效青霉素治疗)时机的不同,分为A组(60例)早期规范干预组(<孕20周),B组(41例)中期规范干预组(孕20-28周),C组(26例)未干预/不完整干预组。A+B组为规范干预组。不良妊娠结局总发生率A组为10.00%,B组为29.27%,C组为69.23%,差异有统计学意义(χB2=6.174,PB=0.013;χ2C=31.63,PC=0.000)。其中早产/低体重B组为26.83%,C组为50.00%,差异有统计学意义(χ2B=4.93,PB=0.026;χ2C=16.86,PC=0.000)。C组的不良妊娠结局高于规范干预的A+B组,差异有统计学意义(χ2=26.91,P=0.000);C组新生儿先天梅毒发生率为19.23%,A+B组为0.99%,差异有统计学意义(χ2=11.50,P=0.001)。快速血浆反应素球状卡片试验(RPR)滴度不同的妊娠梅毒患者,经规范干预后,规范干预组与未干预/不完整干预组的妊娠不良结局发生率差异有统计学意义(χ2高=13.01,P高=0.000;χ2低=7.65,P低=0.006),新生儿先天梅毒发生率差异也有统计学意义(χ2高=4.94,P高=0.026;P低=0.017)。结论早期规范治疗对改善妊娠梅毒患者的妊娠结局及降低先天梅毒发生率有着重要意义,不论患者RPR滴度高低,妊娠梅毒患者均应早期进行积极的规范治疗。

Objective To investigate the influence of different intervention times on the prognosis of syphilis in pregnancy.Methods A total of 127 pregnant women with syphilis were recruited from 2008 to 2012.A retrospective study was conducted to evaluate the pregnancy outcomes of different intervention times and a comparison was made among those groups.Results A total of 127 pregnant women were divided into three groups based on the stage of pregnancy when the first dose of penicillin were given,group A（≤20gestational weeks,60cases）,group B（from20to 28 gestational weeks,41cases）,group C（untreated/inadequate treated,26cases）and RPR titer（≤1∶8,1∶8）respectively.Group A and B together were considered as a standardly treated group A＋B.The incidence of premature or low birth weight in group A was 10.00% and significantly lower than that in group B（26.83%）and group C（50.00%）（χ2B=4.93,PB=0.026;χ2C=16.86,PC=0.000）,and the incidence of total adverse outcomes in group A（10.00%）was also lower than that in group B（29.27%）and group C（69.23%）（χ2B=6.174,PB=0.013;χ2C=31.63,PC=0.000）.The total incidence of adverse outcomes in group C exceeded that in group A＋B（17.82%）（χ2=26.91,P=0.000）,the incidence of neonatal congenital syphilis was 19.23% higher in group C than that in group A＋B（0.99%）（χ2=11.50,P=0.001）.Benefiting from standard treatment,the difference between incidences of adverse pregnancy outcomes in group A＋B and group C displayed a statistical significance with different levels of RPR titers（χ2high=13.01,Phigh=0.000;χ2low=7.65,Plow=0.006）,and the incidences of neonatal congenital syphilis was similarly improved（χ2high=4.94,Phigh=0.026;Plow=0.017）.Conclusion Early standard treatment had a positive effect on the prognosis of syphilis in pregnant women.Despite the RPR levels,patients should be aggressively treated once diagnosed.