武汉市227913例孕产妇梅毒感染状况及流行病学特征

Analysis of syphilis infection status and epidemiological characteristics among 227 913 pregnant women in Wuhan

目的了解武汉地区孕产妇梅毒感染状况和相关流行病学特征,为进一步完善预防梅毒母婴传播工作提供依据。方法在2011年5月-2014年5月武汉市孕期进行产前检查或分娩的孕产妇中随机选取227 913例,采用酶联免疫吸附测定法（ELISA）、明胶颗粒凝集法（TPPA）和甲苯胺红不加热血清试验（TRUST）3种方法同时进行梅毒血清学检测,对阳性孕产妇进行随访管理。结果孕产妇梅毒感染率为1.89‰,4年间感染率逐年上升（P〈0.01）。感染梅毒孕产妇年龄多在23~30岁,文化程度和收入水平普遍较低,妊娠早期进行首次产前检查和确诊比例分别为42.33%、14.65%,其中文化程度、首次产检孕周与梅毒感染孕产妇确诊孕周有关（P〈0.01）。市外户籍、初中以下文化梅毒感染孕产妇的失访比例较高。结论武汉市孕产妇梅毒感染率呈低水平、小幅上升状态。下一步应加强重点人群的产前保健健康教育,以孕早期筛查作为预防手段,以规范化治疗和完善的随访管理为主要措施,最大限度减少武汉市梅毒母婴传播的发生。

Objective To understand the status and epidemiological characteristics of syphilis infection among pregnant women in Wuhan,and to provide a theoretical basis for further improvement in the prevention of mother-to-child transmission. Methods 227913 samples were randomly selected from pregnant women who took prenatal examination or delivered in Wuhan during the period of May 2011- May 2014. Syphilis was diagnosed by using the methods of ELISA,TPPA and TRUST concurrently to detect the blood samples,and follow-up management was conducted among positive cases. Results The infection rate of syphilis among pregnant women in Wuhan was 1. 89‰,and a gradually increasing rate was observed during the 4 years（ P 〈 0. 01）. The majority of infected pregnant women were aged between 23 to 30 years,with lower educational level and income. Among the infected women,a proportion of 42. 33% had their first prenatal examination during early pregnancy,and 14. 65% were diagnosed in the first trimester. The gestational age of infection diagnosed was associated with educational level and the gestational age of attending first prenatal care（ P 〈0. 01）. The proportion of loss to follow-up was much higher among infected pregnant women who were household registered out of Wuhan and who had the educational level below junior high school. Conclusion The infection rate of syphilis among pregnant women in Wuhan is relatively low,with a mildly increasing trend. Prenatal care education for the key population should be strengthened in the next step. Early screening in the first trimester should be taken as the major preventive method,and the standardized treatment and completed follow-up should be taken as primary measures,in order to substantially reduce the occurrence of fetal syphilis infection.