上海市2013年至2015年梅毒感染孕产妇治疗情况及其不良妊娠结局相关因素分析

Treatment status of maternal syphilis infection and factors associated with their adverse pregnant outcomes in Shanghai during 2013-2015

目的探索影响上海市梅毒感染孕产妇治疗依从性,以及发生梅毒相关不良妊娠结局的相关危险因素。方法本研究以2013年1月至2015年12月在上海市妊娠梅毒监测系统中登记的所有确诊妊娠梅毒孕产妇为研究对象,建立前瞻性队列,共发现妊娠梅毒1 717例,随访到治疗和妊娠分娩结局1 147例。同时收集梅毒感染孕产妇的检测/治疗信息及其新生儿的健康结局。采用χ^2检验进行单因素分析,logistic回归分析等统计学方法评价影响妊娠期治疗和不良妊娠结局发生的相关因素。结果研究期间685例孕产妇在妊娠期接受了梅毒治疗,治疗率为59.7%;397例(34.6%)进行了2个疗程的全程治疗。文化程度低、无业/待业者、经产妇者的治疗依从性较差,且妊娠晚期确诊的孕产妇接受梅毒治疗和完成全程治疗的比例为34.9%(142/407)和10.1%(41/407);妊娠期治疗可以显著改善孕产妇分娩前末次非梅毒螺旋体检测转阴率(39.1%比3.7%)。妊娠期梅毒全程治疗是减少新生儿死亡[调整相对危险度(adjusted relative risk,aRR)=0.05,95%可信区间(confidence interval,CI:0.01~0.37,P=0.003]、早产/低出生体质量发生(aRR=0.44,95%CI:0.27~0.70,P=0.001)的保护因素,而末次非梅毒螺旋体检测强阳性者会增加新生儿死亡(aRR=12.89,95%CI:1.70~100.43,P=0.014)、早产/低出生体质量(aRR=2.78,95%CI:1.52~5.06,P=0.001)的风险。结论文化程度、职业状况、孕产史等因素会影响妊娠期梅毒治疗依从性;早期梅毒诊断和全程化治疗可以有效地改善妊娠结局和新生儿的健康状况。

Objective To analyze the factors associated with syphilis treatment compliance and adverse pregnant outcomes among pregnant women with syphilis in Shanghai.Methods The prospective cohort was established based on maternal syphilis monitoring system of Shanghai,which included all the pregnant women diagnosed with syphilis during Jan 2013 to Dec 2015.A total of 1 717 pregnant women with syphilis were recruited at the baseline,and 1 147 of them were followed up during treatment and their pregnancy,and the delivery outcomes were recorded.The information of testing/treatment of pregnant women with syphilis and health outcomes of infants were collected.Chi-square test was used for univariate analysis and logistic regression model was used to identify the factors associated with syphilis treatment and adverse pregnant outcomes.Results A total of 685 participants received syphilis treatment during pregnancy,with the treatment rate of 59.7%.Among them,397(34.6%)patients underwent two courses of complete treatment.The poor educated,unemployed/job-waiting or multipara population had poor compliance to treatment.Only 34.9%(142/407)of cases diagnosed at last trimester received syphilis treatment and 10.1%(41/407)completed the treatment.The proportion of non-treponemal conversion were higher in subjects who received syphilis treatment during pregnancy than those who did not(39.1%[268/285]vs 3.7%[17/462]).Complete syphilis treatment during pregnancy was protective factor to decrease neonatal death adjusted relative risk([aRR]=0.05,95%CI:0.01-0.37,P=0.003)and prematurity/low birth weight(aRR=0.44,95%CI:0.27-0.70,P=0.001).Strong positive non-treponemal result before delivery increased the risks of neonatal death(aRR=12.89,95%CI:1.70-100.43,P=0.014)and prematurity/low birth weight(aRR=12.78,95%CI:152-5.06,P=0.001).Conclusions Factors such as educational level,employment status,and maternal history will affect the compliance of syphilis treatment during pregnancy.Early diagnosis and complete treatment course of syphilis could improve the pregnant outcomes and the health status of infants.