孕产妇梅毒感染确诊时机影响因素

Influencing factors of timing of diagnosis of syphilis infection in pregnant women

目的分析孕产妇梅毒感染确诊时机的影响因素及临床治疗效果。方法选择2017年9月-2019年9月于海口市妇幼保健院接受定期产检的孕产妇为研究对象,采用巢式病例对照研究方式将孕期确诊梅毒的80例孕妇纳入孕期确诊组,按1∶2比例匹配160例产期确诊梅毒的患者纳入产期确诊组;分析患者年龄、孕产次等临床资料,归纳孕产妇不同时期确诊梅毒感染的影响因素,并比较两组治疗效果。结果两组民族、户籍、文化程度、职业、孕次、梅毒分期、感染途径比较差异无统计学意义,但产次、子女数及性伴侣感染比例比较差异有统计学意义(P<0.05),多因素分析结果显示产次、子女数、性伴侣感染是孕产妇不同时期确诊梅毒感染的影响因素(P<0.05);孕期确诊组不良妊娠结局发生率为22.50%(18/80)低于产期确诊组(P<0.001),先天性梅毒发生率为5.00%(4/80)低于产期确诊组(P<0.001)。结论产次、子女数、性伴侣感染是孕产妇不同时期确诊梅毒感染的影响因素,孕期确诊梅毒患者经治疗后具更低的不良妊娠结局风险及先天梅毒感染风险。

OBJECTIVE To analyze the factors influencing the timing of diagnosis of syphilis infection in pregnant women and the effect of clinical treatment. METHODS Pregnant and lying-in women received regular antenatal examinations at Haikou Maternal and Child Health Hospital from Sep. 2017 to Sep. 2019 were selected as the research subjects. Using a nested case-control study method, 80 pregnant women diagnosed with syphilis during pregnancy were included in the pregnancy diagnosis group, and 160 cases diagnosed with syphilis during the perinatal period were matched with a 1∶2 ratio to be included in the puerperium diagnosis group. The clinical data of age, gravidity and parity of patients were analyzed, the factors affecting the diagnosis of syphilis infection in pregnant women at different stages were summarized, and the treatment effects of the two groups were compared. RESULTS There was no significant difference between the two groups in terms of ethnicity, household registration, education level, occupation, gravidity, syphilis staging and infection route, while there were significant differences in parity, number of children and sexual partner infection ratio(P<0.05). The results of multivariate analysis showed that parity, number of children and sexual partner infection were the influencing factors for the diagnosis of syphilis infection in different periods of pregnant women(P<0.05). The incidence of adverse pregnancy outcomes in the pregnancy diagnosis group was 22.50%(18/80), significantly lower than that of the puerperal diagnosis group, and the incidence of congenital syphilis was 5.00%(4/80), significantly lower than in the puerperal diagnosis group(P<0.05). CONCLUSION The parity, number of children and sexual partner infection are the factors that influence the diagnosis of syphilis infection in pregnant women at different stages. Patients with syphilis diagnosed during pregnancy have a lower risk of adverse pregnancy outcomes and congenital syphilis infection after treatment.