驱梅治疗时机对妊娠期梅毒患者妊娠结局、母婴快速血浆反应素试验结果及新生儿Apgar评分和胎传梅毒的影响

Effects of palliative therapy timing on pregnancy outcome,maternal and infant RPR titer,Apgar score of newborn and fetal transmission of syphilis in patients with gestational syphilis

目的:探讨不同驱梅治疗时机对妊娠期梅毒患者妊娠结局,母婴快速血浆反应素试验(RPR)结果,新生儿Apgar评分以及胎传梅毒的影响。方法:选择甘肃省第二人民医院与玛曲县人民医院2019年1月至2021年12月收治的100例妊娠期梅毒患者作为研究对象,按照接受驱梅治疗时机的不同分成3组,其中早期组(孕<12周)38例,中期组(孕12~27周)32例,晚期组(孕≥28周)30例。比较3组不良妊娠结局情况、母婴RPR滴度、新生儿出生后1 min和5 min的Apgar评分及新生儿胎传梅毒发病率。结果:早期组、中期组和晚期组的不良妊娠结局发生率分别为7.89%(3/38)、34.38%(11/32)和53.33%(16/30),其中早期组不良妊娠结局发生率显著低于中期组和晚期组(P<0.05)。早期组和中期组妊娠期患者RPR滴度<1∶8的比率均显著高于晚期组(P<0.05);早期组新生儿RPR滴度<1∶8的比率显著高于中期组和晚期组(P<0.05)。早期组新生儿出生后1 min和5 min Apgar评分均显著高于中期组和晚期组(P<0.05);中期组新生儿出生后1 min和5 min Apgar评分均显著高于晚期组(P<0.05)。早期组、中期组及晚期组胎传梅毒发生率分别为0(0/38)、6.25%(2/32)及26.67%(8/30),早期组和中期组胎传梅毒发生率均显著低于晚期组,差异有统计学意义(P<0.05)。结论:妊娠期梅毒患者在孕早期进行驱梅治疗可有效减少不良妊娠结局、降低母婴RPR滴度,并能有效阻断梅毒垂直传播,降低胎传梅毒的发生风险。

Objective:To investigate the effects of palliative therapy timing on pregnancy outcome,maternal and infant rapid plasma reaction test(RPR)titer,Apgar scores at 1 min and 5 min after birth,and fetal transmission of syphilis in patients with gestational syphilis.Methods:A total of 100 syphilis patients with pregnancy admitted to The Second People's Hospital of Gansu Province and Maqu County People's Hospital from January 2019 to December 2021 were selected as study objects.According to the time points of implementing plum blossoms treatment,these subjects were divided into three groups,including 38 cases in the early group(<12 weeks of pregnancy),32 cases in the intermediate group(12-27 weeks of pregnancy),and 30 cases in the late group(≥28 weeks of pregnancy).The adverse pregnancy outcomes,maternal and infant RPR titer,Apgar scores at 1min and 5 min after birth,and incidence of neonatal syphilis were compared among the three groups.Results:The incidences of adverse pregnancy outcomes in the early,intermediate and late groups were 7.89%(3/38),34.38%(11/32)and 53.33%(16/30),respectively.The incidence of adverse pregnancy outcomes in the early group was significantly lower than that in the middle and late groups(P<0.05).Maternal RPR titers<1∶8 ratio in early and intermediate groups were significantly higher than that in the late group(P<0.05).The RPR titer<1∶8 ratio in the early group was significantly higher than that in the intermediate and late groups(P<0.05).The Apgar scores at 1 min and 5 min after birth in the early group was significantly higher than that in the intermediate group and late group(P<0.05).Apgar scores at 1 min and 5 min after birth in metaphase group were significantly higher than those in the late group(P<0.05).The incidences of fetal syphilis were 0(0/38),6.25%(2/32)and 26.67%(8/30)in the early group,the intermediate group,and the late group,respectively.The incidences of fetal syphilis in the early group and the intermediate group were significantly lower than that in the late group(P<0.05).Conclusion:Early pregnancy with syphilis can effectively improve pregnancy outcome,reduce maternal and infant RPR titer,effectively block the vertical or fetal transmission of syphilis.