孕早期梅毒阳性孕妇血清学监测合理频次的探讨

Rational interval of serology monitoring among early pregnant women with Treponema pallidum infection

目的探讨孕早期梅毒阳性孕妇血清学监测的合理频次。方法孕(12±1)周梅毒颗粒凝聚(treponema pallidum particle agglutination, TPPA)试验阳性和快速血浆反应素(rapid plasma reagin, RPR)试验阳性且既往梅毒感染史阴性,并在孕28~32周和临产前4周内完成梅毒血清学检查的孕妇53例,根据自孕(12±1)周起是否每月复查,分为每月监测(monitor per month, MPM)组(15例)和非每月监测(monitor non per month, MNPM)组(38例,超过8周未复查),比较MPM组和MNPM组发现孕妇治疗失败或再感染的比例以及发生新生儿先天性梅毒的比例。结果 MPM组新生儿先天性梅毒病例比例(0/15)明显少于MNPM组(9/29, P <0.05),发现孕妇治疗失败或再次感染病例比例(4/11)统计学上高于MNPM组(2/36, P <0.05)。MPM组孕妇治疗失败或再次感染4例,增加了1个疗程青霉素静滴抗梅毒治疗,后期随访中RPR逐渐下降,分娩前4周内再次给予1个疗程抗梅毒治疗,整个孕期共3个疗程,无新生儿先天性梅毒发生。MNPM组孕妇治疗失败或再感染2例和另外RPR滴度较孕(12±1)周无升高7例,均在分娩前完成了2个疗程的抗梅毒治疗,仍发生了新生儿先天性梅毒。结论孕早期梅毒阳性的孕妇每月监测梅毒滴度并及时治疗,可以减少新生儿先天性梅毒的发生。

Objective To estimate the rational interval of serological monitoring among early pregnant women with Treponema pallidum (TP) infection.Methods Fifty three pregnant women with positive TP particle agglutination (TPPA) assay and positive rapid plasma reagin (RPR) test (TPPA +RPR +) at gestational (12±1) weeks and without syphilis history,who underwent syphilis monitoring at gestational 28-32 weeks and within 4 weeks before delivery,were enrolled in the study.Among them 15 cases received serological monitoring every month from gestational (12±1) weeks (MPM group) and 38 cases received monitoring not per month (MNPM group).The proportions of treatment failure or reinfection,and the proportion of cases with neonatal congenital syphilis (NCS) were compared between MPM group and MNPM group.Results There was significant difference in proportion of NCS between MPM group and MNPM group(0/15 vs 9/29,P <0.05).The proportion of detected treatment failure or reinfection in MPM group was significantly higher than that in MNPM group (4/11 vs 2/36,P <0.05).In MPM group 4 cases with treatment failure or reinfection received an additional course of intravenous drip penicillin timely,and RPR titers declined gradually;within 4 weeks before delivery the 4 cases received another course of treatment,and no NCS took place.In MNPM group 2 cases with treatment failure or reinfection and 7 cases whose RPR titers were not higher than that at gestational (12±1) weeks,all gave birth of newborns with NCS,although 2 courses of treatment were given before delivery.Conclusion For pregnant women with TP infection in early pregnancy,monthly serological monitoring and timely treatment will reduce NCS.