妊娠梅毒孕期全程随访及其影响因素分析

Whole-term follow-up of pregnant women with syphilis in pregnancy and its related influencing factors

目的分析深圳市南山区妊娠合并梅毒患者全程随访情况及其影响因素。方法选取2003年1月1日至2017年12月31日于深圳市南山区各助产机构确诊的986例妊娠梅毒患者为研究对象,通过标准化孕产妇梅毒病历记录患者一般人口学信息、治疗信息、实验室检测结果、妊娠结局等内容,采用多因素非条件Logistic回归模型分析妊娠梅毒患者全程随访影响因素。结果986例妊娠梅毒患者中,完成全程随访者692例,全程随访率70.18%。Logistic回归结果显示年龄在25岁以上、就诊时21~36孕周、就诊时≥37孕周、配偶有性病史、疾病分期为一期/二期梅毒是促进全程随访的独立因素,家务和待业以外的职业是完成全程随访的阻碍因素,OR值及95%CI分别为3.32(2.44~4.50)、2.10(1.35~3.27)、1.72(1.03~2.89)、4.05(1.98~8.30)、3.03(1.47~6.25)和0.56(0.42~0.75),均P<0.05。结论妊娠梅毒患者全程随访率受到年龄、职业、就诊时孕周、配偶性病史、疾病分期等因素影响,建议针对不同患者特征以及健康需求,建立一站式公共卫生服务模式,实施引导策略,更好的为妊娠梅毒患者提供全程随访服务。

Objective To analyze whole-term follow-up situation of pregnant women with syphilis in pregnancy(SP)in Nanshan district of Shenzhen city and its influencing factors.Methods 986 pregnant women with syphilis in pregnancy confirmed in midwifery institutions in Nanshan district of Shenzhen city over a period from January 1,2003 to December 31,2017 were selected as research subjects.From standardized maternal syphilis medical records,general demographic information,treatment,laboratory test results,pregnancy outcomes of the patients were collected.Using multiple factor unconditioned logistic regression model,all factors influencing whole-term followed up of the pregnant women with SP were analyzed.Results Among 986 pregnant women with SP,692 pregnant women were followed-up in their whole gestational period,and the whole-term follow-up rate was 70.18%.Logistic regression results showed that age of the pregnant woman more than 25 years,21~36 weeks of gestational age at visit,eaqual to and more than 37 weeks of gestational age at visit,spouse history of sexually-transmitted disease(STD),the first/second stages of syphilis were all independent factors to promote the whole-term follow-up,while occupations except housework and job-waiting of the pregnant women were the impeding factors of the whole-term follow-up,the OR value(95%CI)were 3.32(2.44~4.50),2.10(1.35~3.27),1.72(1.03~2.89),4.05(1.98~8.30),3.03(1.47~6.25)and 0.56(0.42~0.75)respectively,all P<0.05.Conclusion The arrival rate of whole-term follow-up of the patients with SP is affected by such factors as age,occupation,gestational age at visit,spouse’s STD history and disease stage,etc.It is recommended that focusing on different patient characteristics and health needs,an one-stop public health service model should be established,and guiding strategies are implemented to provide whole-term follow-up services for those pregnant women with SP.