青岛市2015-2021年梅毒感染孕产妇治疗情况及影响因素分析

Treatment for maternal syphilis and associated factors in Qingdao,Shandong Province,2015-2021

目的分析青岛市2015-2021年梅毒感染孕产妇治疗情况及影响因素。方法从国家预防艾滋病、梅毒和乙肝母婴传播信息管理系统收集符合标准的梅毒感染孕产妇个案信息,描述其社会人口学特征、孕产史、梅毒感染情况及治疗情况等,采用χ^(2)检验和Logistic回归模型分析梅毒感染孕产妇孕早期及确诊后7天及以内开始治疗的影响因素。结果共计调查1767例梅毒感染孕产妇,有73.12%(1292例)在孕产期接受了治疗,其中孕早期开始治疗者占24.92%(322例),确诊后7天及以内开始治疗者占77.24%(998例)。2015-2021年,梅毒感染孕产妇治疗率由51.18%(87/170)上升到96.09%(221/230)(χ_(趋势)^(2)=182.051,P<0.001),孕早期开始治疗者构成比由17.24%(15/87)上升到39.37%(87/221)(χ_(趋势)^(2)=244.555,P<0.001)。多因素分析发现,孕早期初检(OR=53.588,95%CI:7.368~389.772)、既往有梅毒感染史(OR=1.385,95%CI:1.014~1.891)、公立机构确诊(OR=2.013,95%CI:1.314~3.085)是孕早期开始治疗的保护性因素;孕次≥3次(OR=1.445,95%CI:1.082~1.931)、孕晚期及产时确诊(OR=2.724,95%CI:1.733~4.283)、公立机构确诊(OR=1.946,95%CI:1.381~2.742)是确诊后7天及以内开始治疗的保护性因素,高中及以上文化程度(OR=0.626,95%CI:0.458~0.855)是确诊后7天及以内开始治疗的危险因素。结论青岛市梅毒感染孕产妇孕早期及确诊后7天及以内开始治疗比例均较低,应采取综合措施,在提高治疗率的同时尽量做到早筛查、早诊断、早治疗,避免先天梅毒的发生。

Objective To analyze the treatment status of syphilitic pregnant women and associated factors in Qingdao,Shandong Province,from 2015 to 2021.Methods The information on syphilitic pregnant women who complied with the study standards was collected.Data were from the National Management Information System for the Prevention of Mother-to-child transmission of HIV,syphilis,and Hepatitis B.Demographic characteristics,information on gestational history,syphilis infected status and status of treatment were gathered.The Chi-square test and logistic regression model were applied to analyze the associated factors with treatment started in early pregnancy and within seven days or less after diagnosis.Results A total of 1767 syphilitic pregnant women were analyzed,with 73.12%(1292)receiving treatment during pregnancy or maternity.Among those,24.92%(322)started treatment in early pregnancy and 77.24%(998)started treatment within seven days or less after diagnosis.From 2015 to 2021,the treatment rate increased from 51.18%(87/170)to 96.09%(221/230)(χ_(trend)^(2)=182.051,P<0.001),and the proportion of treatment started in early pregnancy increased from 17.24%(15/87)to 39.37%(87/221)(χ_(trend)^(2)=244.555,P<0.001).The multivariate logistic analysis found that the first prenatal care in the early pregnancy(OR=53.588,95%CI:7.368-389.772),history of syphilis infection(OR=1.385,95%CI:1.014-1.891),diagnosis in public institutions(OR=2.013,95%CI:1.314-3.085)were the protective factors for treatment started in early pregnancy.3 times and above pregnancies(OR=1.445,95%CI:1.082-1.931),diagnosis in the middle and late pregnancy(OR=2.724,95%CI:1.733-4.283)and diagnosis in public institutions(OR=1.946,95%CI:1.381-2.742)were the protective factors for treatment started within seven days or less after diagnosis.High school education and above was the risk factor for treatment started within seven days or less after diagnosis(OR=0.626,95%CI:0.458-0.855).Conclusions The proportion of treatment started in early pregnancy and within seven days or less after diagnosis is low in Qingdao.In order to avoid congenital syphilis,we should take some measures to improve the time of early screening,diagnosis and treatment in line with improving the treatment rate.