379例孕产妇梅毒、艾滋病和乙型肝炎病毒感染情况及妊娠结局分析

Analysis on Treponema pallidum,human immunodeficiency virus,and hepatitis B virus infection situations and pregnancy outcomes among 379 pregnant women

目的探讨孕产妇人类免疫缺陷病毒(HIV)、乙型肝炎病毒(HBV)、梅毒螺旋体(TP)感染情况及母婴垂直传播情况,并对妊娠结局进行分析。方法将2012-2014年成都市公共卫生临床医疗中心收治的379例HIV、TP、HBV感染孕产妇按照感染情况分型,另选取同期90例正常孕产妇为对照组。统计不同类型传染病的构成情况、孕产妇妊娠结局及垂直感染情况,分析母婴垂直传播相关因素。结果孕产妇单一HIV感染者占22.2%~25.0%,单一TP感染者占24.8%~28.5%,单一HBV感染者占37.4%~38.3%,合并两种或以上感染者占0.8%~6.9%,"三病"感染类型比较,差异无统计学意义(P>0.05)。合并HIV、TP、HBV感染孕产妇的总流产率为4.7%(18/379),死胎率为1.6%(6/379),早产率为8.9%(34/379),其中单一感染TP者流产率(7.0%,7/100)、死胎率(4.0,%,4/100)以及早产率(11.0%,11/100)均最高,合并"三病"感染者不良妊娠结局发生率明显高于对照组(P<0.05)。总体垂直传播率为4.6%(16/350),单一合并TP感染者最高(7.9%,7/79),其次为单一合并HBV感染者(4.3%,6/138),不同感染类型垂直传播率比较,差异无统计学意义(P>0.05)。母婴垂直传播与是否接受母婴阻断干预措施强相关(r=0.584,P<0.05),与是否合并TP及喂养方式弱相关(r=0.106~0.156,P<0.05)。结论 2012-2014年单一HIV、TP、HBV感染是孕产妇"三病"的主要类型,合并HIV者多合并TP、HBV、丙型肝炎病毒(HCV)、HPV以及结核等感染。"三病"整体母婴垂直传播率控制在较低水平,但是仍存在患者未接受母婴阻断、阻断不彻底及阻断干预效果不佳等问题。

Objective To explore the infection and mother-to-fetus transmission situations of human immunodeficiency virus（HIV）,hepatitis B virus（HBV）,Treponema pallidum（TP） among pregnant women,and analyze the pregnancy outcomes.Methods From 2012 to 2014,379 pregnant women with HIV,TP,and HBV infections in the center were divided into different types according to infection situations;90 normal pregnant women during the same period were selected as control group.The proportions of different types of infectious diseases,pregnancy outcomes,and mother-to-fetus transmission situations were analyzed statistically.The related factors of mother-to-fetus transmission were analyzed.Results The proportions of pregnant women with only HIV infection,only TP infection,and only HBV infection accounted for 22.2%-25.0%,24.8%-28.5%,and 37.4%-38.3%,respectively,and 0.8%-6.9% of the pregnant women were found with two kinds and more than two kinds of diseases.There was no statistically significant difference in the infection types among the three diseases（P〈0.05）.Among the pregnant women complicated with HIV,TP,and HBV infections,the total abortion rate was 4.7%（18/379）,the rate of stillbirth was 1.6%（6/379）,the rate of premature delivery was 8.9%（34/379）;the total abortion rate（7.0%,7/100）,the rate of stillbirth（4.0%,4/100）,and the rate of premature delivery among the pregnant women with only TP infection were the highest.The incidence rate of adverse pregnancy outcomes among the pregnant women complicated with the three diseases was statistically significantly higher than that in control group（P〈0.05）.The total rate of mother-to-fetus transmission was 4.6%（16/350）,which was the highest among the pregnant women with only TP infection（7.9%,7/79）,followed by the pregnant women with only HBV infection（4.3%,6/138）,there was no statistically significant difference in the rate of mother-to-fetus transmission among the pregnant women with different infection types（P〈0.05）.Mother-to-fetus transmission was correlated with accepting intervention measures of mother-to-fetus transmission or not（r = 0.584,P 0.05）,which was weakly correlated with TP infection and feeding patterns（r = 0.106-0.156,P 0.05）.Conclusion Only HIV infection,only TP infection,and only HBV infection were the main three diseases among the pregnant women from 2012 to 2014,the pregnant women with HIV infection were often complicated with TP and HBV,hepatitis C virus,HPV,and tubercle bacillus infection.The rates of mother-to-fetus transmission of the three diseases are controlled at a low level,but there are still some problems,such as not receiving mother-to-fetus transmission blocking,halfway blocking,and poor effect of blocking.