妊娠梅毒患者772例母婴梅毒传播阻断效果回顾性分析

目的探讨干预时机及妊娠梅毒患者血清滴度水平与母婴梅毒传播阻断效果的联系。方法回顾性分析2005-2010年全程随访的772例妊娠梅毒患者,根据患者孕期实施长效青霉素干预治疗的时间分为早期干预组(<28周)、晚期干预组(28～35周)及未干预/不完整干预组,同时根据妊娠梅毒患者甲苯胺红不加热血清试验(TRUST)滴度水平分为低滴度组(≤1:4)、中滴度组(1:8～1:16)及高滴度组(>1:16),研究相同干预时机不同血清TRUST水平对患者妊娠结局的影响,以及相同滴度水平下不同干预时机对患者妊娠结局的影响。结果 535例接受规范治疗干预的患者未发生先天梅毒、早产及新生儿死亡;237例未干预/未完整干预的患者先天梅毒、早产、低体重出生儿、新生儿死亡及死胎发生率分别为2.11%,2.95%,6.75%,1.27%和10.13%;患者在早期(<28周)或晚期(28-35周)接受规范干预均能够获得满意的干预效果;未干预/不完整干预者不良妊娠结局发生率高于规范干预者(P<0.05);未干预/不完整干预妊娠梅毒患者发生不良结局的危险性与血清滴度水平有关(P<0.05)。结论规范青霉素治疗能使妊娠梅毒患者避免发生不良妊娠结局,即使在孕28～35周接受规范干预,仍能获得理想效果;妊娠梅毒患者发生先天梅毒儿、死胎的危险性与血清TRUST滴度水平相关。

Retrospective Study of 772 Pregnant Women on the Effectiveness of Mother-to-child Transmission-blocking of Syphilis

Objective To investigate the relations between intervention timing,TRUST titers and effectiveness of mother-to-child transmission-blocking of syphilis.Methods A retrospective study was conducted,772 pregnant women with syphilis from 2005 to 2010 were divided base on the stage of pregnancy when the first dose of penicillin were given(<28 weeks,28,35weeks,untreated/inadequate treated) and TRUST titre(≤1:4,1:8-1:16,>1:16) respectively.Prematurity,low birthweight,neonatal death,fetal death and the incidence of congenital syphilis were observed and compared at the same treatment timing and at the same TURST titre respectively.Results There were not congenital syphilis,prematurity and neonatal death in 535 patients after adequate intervention.But the rates of congenital syphilis,prematurity,low birthweight,neonatal death,fetal death were 2.11%,2.95%,6.75%,1.27% and 10.13% respectively in 237 patients with no treatment/inadequate treatment.After early(<28weeks) or late(28~35weeks) adequate treatment,the adverse outcomes of the patients could be averted.Patients with different TRUST titers would have a approving blocking result excluding who with no treatment/inadequate treatment(P<0.05).The risk of adverse outcomes was related with the level of TRUST titer in the patients with no treatment/inadequate treatment(P<0.05).Conclusion After appropriate penicillin treatment,patients all could have a approving result,even if the patients were received therapy in 28~35weeks.The risk of congenital syphilis and fatal death was related with the level of TRUST titer in pregnant women with syphilis.