佛山市顺德区妊娠期孕妇梅毒筛查调查及不同干预效果的临床比较

Investigation of syphilis screening and comparison of clinical effects between different interventions in pregnant women during gestation period in Shunde District of Foshan

目的:调查佛山顺德区孕妇妊娠期梅毒感染情况,分析其治疗结果,为该区域孕妇妊娠期梅毒的防治提供参照。方法:对2008年1月至2014年12月于佛山顺德区第四人民医院、广州医科大学附属乐从医院产科作产检的12704例孕妇作梅毒筛查,进行甲苯胺红不加热血清(TRUST)检查,对阳性病例作梅毒螺旋体血清颗粒凝聚(TPPA)试验,对确诊者作治疗干预,分析其妊娠结局。结果:12704例孕妇,筛查确诊为梅毒者58例,妊娠期梅毒发生率为0.46%。妊娠期梅毒患者中流动人口55例,占94.83%;2009年妊娠期梅毒发生率最高,达0.76%,随后逐渐下降,2013年最低,为0.29%,2014年略有上升,占0.37%;47例作全程规范化治疗的妊娠期梅毒患者,共8例出现不良妊娠结局,占17.02%,不同妊娠时间开始治疗的梅毒孕妇,不良妊娠结局发生率对比无统计学差异(P>0.05);妊娠早期开始治疗的梅毒孕妇其新生儿RPR阳性率低于中晚期开始的治疗梅毒孕妇,以晚期治疗新生儿RPR阳性率最高(P<0.05);不同RPR滴度梅毒孕妇不良结局发生率对比差异无统计学意义(P>0.05);PR滴度≤1∶2孕妇,新生儿RPR阳性率50.00%,明显低于RPR滴度≥1∶4梅毒孕妇的91.67%(P<0.05)。结论:重视产前、孕前梅毒筛查,强调在妊娠早期对梅毒孕妇作干预治疗,可预防先天性梅毒,降低不良妊娠结局发生率。

Objectives： To investigate the status of syphilis infection in pregnant women during gestation period in Futian District of Shenzhen and to analyze the treatment results in order to provide reference for the preven- tion and treatment of syphilis in pregnant women in this area. Methods： Syphilis screening was performed in 12704 pregnant women who underwent antenatal examination in the department of obstetrics of the Fourth Peopleg Hospital of Nanhai District, Foshan and Lecong hospital Affiliated to Guangzhou Medical University between January 2008 and December 2014. Toluidine red unheated serum test （TRUST） was also performed. For positive cases, treponema pallidum particle assay （TPPA） was performed. For patients with confirmed diagnosis, therapeutic intervention was given. The pregnancy outcomes were analyzed. Results： In the 12704 pregnant women, 58 cases were diagnosed with syphilis and the incidence rate of syphilis during gestation period was 0. 46%. In pregnant women with syphilis during gestation period, 55 cases were floating population, accounting for 94.83%. In 2009, the incidence of syphilis during gestation period was the highest, reaching 0. 76%. Then, it declined gradually and reached the lowest in 2013 （0. 29% ）. In 2014, it rose slightly, reaching 0. 37%. In the 47 patients with syphilis during gestation period who received whole - course standardized treatment, a total of 8 cases had adverse pregnancy outcomes, accounting for 17.02%. There were no significant differences in the incidence rates of adverse pregnancy outcomes among pregnant women treated in different pregnancy periods （ P 〉 0. 05 ）. The positive rate of RPR in newborns of pregnant women with syphilis treated in early gestation period was lower than that of pregnant women with syphilis treated in middle and late gestation period. The positive rate of RPR in newborns of pregnant women with syphilis treated in late stage was the highest （ P 〈 0. 05 ）. There was no statistically significant differences in the incidence of adverse outcomes among pregnant women with different RPR titers （ P 〉 0. 05 ）. The RPR positive rate in newborns of pregnant women with PR titer≤ 1 ：2 was 50. 00% which was significantly lower than that in pregnant women with syphilis and RPR titer ≥ 1：4 （91.67% ） （P 〈 0. 05 ）. Conclusion： More attention should be paid to prenatal and pre - pregnant syphilis screening and stressing application of interventional therapy in pregnant women with syphilis in early gestation period in order to prevent congenital syphilis and reduce the incidence of adverse pregnancy outcomes.