不同治疗时机对妊娠期梅毒妊娠结局的影响及其危险因素分析

Influence oftreatment timing on the pregnancy outcome of syphilis in pregnancy and analysis of the risk factors

目的:分析妊娠期梅毒危险因素及不同治疗时机对妊娠结局的影响。方法:选取深圳市宝安区人民医院皮肤性病科2014年3月至2016年3月就诊的妊娠合并梅毒病例62例进行观察,回顾本组患者病例资料,其中38例在妊娠≤12周予以青霉素抗梅毒治疗(A组)、24例在妊娠>12周行抗梅毒治疗(B组)。分析两组妊娠结局及新生儿情况,并分析不良妊娠结局的危险因素。结果:A组孕妇足月分娩率为89.47%,高于B组(66.67%),组间数据经统计学分析差异具有统计学意义(P<0.05),且A组孕妇不良妊娠结局较B组低(10.53%vs 33.33%),组间差异具有统计学意义(P<0.05);A组(86.84%)正常新生儿率高于B组(57.89%);且A组(2.63%)先天梅毒儿发生率明显较B组(21.05%)低,组间差异具有统计学意义(P<0.05)。经多因素Logistic回归分析,文化程度低、抗梅毒治疗时间晚和高RPR滴度均是导致妊娠期梅毒不良妊娠结局的危险因素。结论:妊娠期梅毒不良妊娠结局危险因素主要有文化程度低、抗梅毒治疗时间晚和高RPR滴度等。早期足量规则的抗梅毒治疗能有效避免不良妊娠结局,提高新生儿存活率,避免先天梅毒儿。

Objective： To analyze the risk factors of syphilis in pregnancy and the influence of treatment timing on pregnancy outcome. Methods： 62 pregnancy patients complicated with syphilis treated in Bao＇an District People＇s Hospital from March 2014 to March 2016 were selected and their data was reviewed. 38 patients less than 12 weeks of pregnancy were to receive penicillin anti syphilis treatment（ group A）,and 24 ones with outnumbered 12 weeks of pregnancy were to receive anti syphilis treatment（ group B）. The pregnancy outcomes and neonatal conditions of the two groups were analyzed,and the risk factors of adverse pregnancy outcomes were analyzed.Results： The full-term delivery rate of pregnant women in group A was 89. 47%,higher than that of group B（ 66. 67%）,with statistically significant difference（ P〈0. 05）. The incidence of adverse pregnancy outcomes of group A was lower than that of group B（ 10. 53% vs 33. 33%）,with significant differences between the two groups（ P〈0. 05）. The normal neonates rate of group A（ 86. 84%） was higher than that of group B（ 57. 89%）,and the incidence of congenital syphilis in baby of group A（ 2. 63%） was significantly lower than that of group B（ 21. 05%）,all with significant differences between the two groups（ P〈0. 05）. According to multivariate Logistic regression analysis,low educational level,late in receiving anti-syphilis treatment and high titer of RPR were all risk factors that led to adverse pregnancy outcomes. Conclusions： The risk factors leading to adverse pregnancy outcomes are mainly low educational level,late treatment of syphilis and high titer of RPR. Early adequate and regular anti-syphilis treatment can effectively avoid adverse pregnancy outcomes,improve neonatal survival rate,and avoid congenital syphilis.