浙江地区梅毒感染孕产妇治疗现状及不良妊娠结局因素分析

Analysis of the treatment status and adverse pregnancy outcomes of pregnant women with syphilis infection in Zhejiang region

目的:对浙江省梅毒感染孕产妇治疗现状进行调查,分析不良妊娠结局的相关危险因素。方法:将2015年5月-2018年12月浙江省妊娠梅毒监测系统中登记的梅毒感染孕产妇406例为研究对象进行前瞻性研究,随访至妊娠分娩结局319例,统计孕期治疗情况,采用logistic回归分析模型对影响不良妊娠结局的危险因素进行分析。结果:随访到的319例梅毒感染孕产妇中194例接受梅毒治疗,治疗率为60.8%,其中接受规范化治疗112例(35.1%);孕产妇为本科及以上文化程度、在职、初产妇者接受治疗比例高于小学及以下、经产妇、无业/待业者,梅毒确诊时间为孕晚期时接受治疗比例低于孕早期与孕中期(均P<0.05);发生不良妊娠孕妇梅毒确诊时间为孕晚期、确诊时梅毒分期为晚期、未接受治疗及初检RPR滴度≥1:16比例高于良好妊娠孕妇(P<0.05);logistic回归分析显示,初检RPR滴度≥1:16、确诊时梅毒分期为晚期、梅毒确诊时间为孕晚期等是影响梅毒感染孕产妇发生不良妊娠结局的独立危险因素(P<0.05),接受规范化治疗为保护性因素(P<0.05)。结论:本次调查地区梅毒感染孕产妇接受治疗的依从性受文化程度、职业、孕产史等因素影响,梅毒感染孕产妇不良妊娠结局发生率较高,梅毒确诊时间、梅毒分期、接受治疗情况及初检RPR滴度与不良妊娠结局有一定相关性。

Objective:To investigate the treatment status of pregnant women with syphilis infection in Zhejiang province,and to analyze the risk factors of adverse pregnancy outcomes.Methods:A total of 406 pregnant women with syphilis infection registered in syphilis surveillance system of pregnancy in Zhejiang province from May 2015 to December 2018 were studied prospectively,and 319 women were followed up to delivery.The treatment situation during pregnancy of women with syphilis infection was analyzed.Logistic regression model was used to analyze the risk factors of adverse pregnancy outcomes.Results:Among the 319 pregnant women with syphilis infection,194 women were treated their syphilis infection,and the treatment rate was 60.82%.112(35.11%)women had received standardized treatment.The treatment proportion of women with higher education level(bachelor degree or above),of women in service,and primipara was significant higher(P<0.05).The proportion of adverse pregnancy outcomes of these women with without treatment,or with initial RPR titer≥1:16 was significant higher(P<0.05).Logistic regression analysis showed that initial RPR titer≥1:16,diagnosed as advanced stage of syphilis infection,and syphilis infection diagnosed during the third trimester of pregnancy were the independent risk factors of adverse pregnancy outcomes of women with syphilis infection(P<0.05),but standardized treatment was a protective factor(P<0.05).Conclusion:In this survey,the treatment compliance of pregnant women with syphilis infection is affected by education level,occupation,pregnancy and childbirth history.The incidence of adverse pregnancy outcomes of pregnant women with syphilis infection was high,and the diagnosis time of syphilis infection,syphilis stage,treatment status,and RPR titer of initial examination were correlated with pregnancy outcomes.