中国华东地区感染梅毒孕产妇血清学指标监测分析

Serologic surveillance indicators analysis among syphilis-infected pregnant women in East China

目的 分析2013年中国华东地区梅毒感染梅毒的孕产妇孕期非梅毒螺旋体抗原血清学试验检测和滴度变化情况及滴度有效控制相关因素.方法 数据来源于2013年＂中国预防艾滋病、梅毒和乙肝母婴传播管理信息系统＂,选择其中华东地区报告的分娩日期在2013年1月1日至12月31日梅毒螺旋体抗体阳性的孕产妇为研究对象,共5206例.收集人口学特征、实验室检测和药物治疗等信息,描述孕期非梅毒螺旋体抗体滴度监测情况和滴度分布特征,比较规范与非规范滴度监测、基线与分娩前/孕晚期孕妇的构成差异,并将基线和分娩前/孕晚期滴度均有记录的3940例孕产妇纳入孕期非梅毒螺旋体抗体滴度有效控制的多因素logistic回归分析.结果 研究对象的年龄为（28.1±5.8）岁.接受了青霉素治疗、其他替代方案治疗和未治疗的孕产妇分别为2967（57.0%）、281 （5.4%）和1958例（37.6%）.349例（6.7%）孕产妇的滴度转阴,251例（4.8%）降低4倍及以上,而有28例（0.5%）升高4倍及以上.与无既往感染史的孕产妇相比,有既往感染史者孕期滴度得到有效控制的OR（95%CI）值为1.49（1.18~1.88）;与≤28孕周就已开始治疗者相比,〉28孕周开始治疗者或未治疗者孕期滴度得到有效控制的OR（95%CI）值为4.09（3.19~5.24）;与青霉素治疗组相比,其他替代方案治疗组和未治疗组的孕期滴度得到有效控制的OR（95%CI）值分别为2.35（1.46~3.76）和1.55（1.13~2.12）.结论 我国华东地区感染梅毒的孕产妇中孕期非梅毒螺旋体抗体滴度转阴或者降低4倍及以上者所占比例较少,无既往梅毒感染史、孕期及早开始治疗和接受青霉素治疗的感染孕产妇孕期滴度易得到控制.

Objective To analyze serologic surveillance indicators during pregnancy among syphilis-infected women who delivered in 2013 in East China. Methods Data were from national＇Information System of Prevention of Mother-to-child Transmission of HIV,syphilis and HBV Management＇ and in total 5 206 syphilis-infected pregnant women who delivered in 2013 and in East China were involved in the analysis. Information on demographic characters, laboratory tests, and treatment regimens were collected. The maternal non-treponemal testing surveillance and titer distribution were described and compare the proportions between pregnant women receiving standard testing and non-standard testing, taking baseline testing and testing before delivery or at the third trimester. Multivariate logistic regression model was analyzed using maternal titer control as dependent variable, using prior history of syphilis infection, syphilis stages, titer, gestational weeks of treatment initiation and treatment regimens as independent variables in 3 940 pregnant women with both baseline testing results and testing results before delivery or at the third trimester. Results The ages of the 5 206 syphilis infected pregnant women were （28.1±5.8）years old.The numbers of women received penicillin treatment,other treatment regimens and no treatment were 2 967 （57.0%）, 281 （5.4%）, and 1 958 （37.6%）, respectively. The number of women with maternal seroconversion,4-fold or greater titer decline,or titer increase were 349（6.7%）,251（4.8%）and 28 （0.5%）. Multivariate analysis results showed that compared with pregnant women with prior history of syphilis,the OR（95% CI）for maternal titer control was 1.49（1.18-1.88）among those with syphilis-infection history.Compared with pregnant women initiated treatment at 28 gestational weeks or before,the OR（95 %CI）for maternal titer control was 4.09（3.19-5.24）among those who initiated treatment after 28 gestational weeks.Compared with pregnant women initiated treatment at 28 gestational weeks or before,the OR（95 % CI）for maternal titer control was 4.09（3.19-5.24）among those who initiated treatment after 28 gestational weeks or received no treatment.Compared with pregnant women received penicillin treatment,the OR（95 % CI）for maternal titer control among those received non-penicillin treatment and those received no treatment were 2.35 （1.46-3.76） and 1.55 （1.13-2.12）, respectively. Conclusion In East China, the proportion of women achieved seroconversion or 4-fold or greater titer decline during pregnancy was very low. Pregnant women with no prior history of syphilis infection, early maternal initiation of treatment, and penicillin treatment were more likely to reach maternal titer control.