2018—2020年深圳市宝安区消除母婴传播门诊联合服务体系建设与效果评估

Effect evaluation on the joint service system of elimination of mother-to-child transmission clinic in Baoan district of Shenzhen City 2018—2020

目的分析总结深圳市宝安区"消除母婴传播门诊"(E门诊)联合服务体系的建设及运行情况,为其他地区消除母婴传播提供借鉴经验。方法自2018年11月起,宝安区推动辖区18家助产医院于产科建立E门诊,形成区域性联合服务体系(E-联体),为感染梅毒和乙肝的孕产妇提供全程的检测、治疗和产检服务。分析E门诊建立前后辖区梅毒和乙肝感染孕产妇各项检测率、治疗率和母婴传播率等指标变化趋势。结果E-联体运行前后,梅毒感染产妇孕期规范治疗率由2018年的67.82%上升至2020年的86.73%;乙肝感染产妇孕期DNA检测率和高病载治疗率由2018年的49.59%和28.68%分别上升至2020年的91.94%和83.98%,差异均有统计学意义。先天梅毒报告发病和乙肝母婴传播变化差异则无统计学意义。结论深圳市宝安区E-联体是区妇幼保健院为主导,辖区各助产机构配合,以E门诊为服务单元所构建的全新服务模式,但因运行时间较短,仍需更多样本来观察该模式长远的运行成效。

Objective To analyze and summarize the constructions and implementation of the joint service system of elimination of mother-to-child transmission clinic(E-clinic)in Baoan district,and to provide reference for other areas to eliminate mother-to-child transmission.Methods Baoan district had promoted to establish E-clinic in 18 hospitals to form regional joint service system,pregnant women who were infected syphilis or hepatitis B were provided whole detections,treatment and antenatal care services.The change trends of detection rate,treatment rate and the mother-to-child transmission rate before and after E-clinic establishment were analyzed.Results The normalized treatment rate of maternal syphilis infection had raised from 67.82%in 2018 to 86.73%in 2020,the maternal HBV-DNA detection rate and antiviral therapy with high viral load had risen from 49.59%and 28.68%in 2018 to 91.94%and 83.98%in 2020,all the differences were statistically significant.There had no statistical differences found between mother-to-child transmission of syphilis and hepatitis B.Conclusion The E-joint service system was a brand new service mode,more samples are still needed to observe the long-term operation effect of this mode.