淮安市568例妊娠合并梅毒母儿结局分析

摘要

目的 研究淮安市妊娠合并梅毒的发病趋势,探讨驱梅治疗对妊娠结局及新生儿梅毒感染的影响.方法 收集淮安市2011年1月至2016年5月妊娠合并梅毒患者662例,分析妊娠合并梅毒孕妇年龄、孕次、梅毒治疗情况与妊娠结局,以及新生儿0 ～18个月随访结果.结果 ①发病率:2011-2016淮安市孕产妇妊娠合并梅毒的6年平均发病率为1.94‰,6年间年发病率分别为0.50‰、1.94‰、2.23‰、2.30‰、2.71‰、2.06‰,经分析年发病率比较差异有统计学意义(x2=45.625,P＜0.001),呈逐年增高的趋势.②分析568例已有妊娠结局孕妇,结果显示:规范治疗组、未规范治疗组、未治疗组间足月产比例差异有统计学意义(x2 =26.926,P＜0.001),规范治疗组足月产比例最高.孕妇快速血浆反应素环状卡片试验(RPR)首检滴度大于1:16者不良妊娠结局较RPR首检滴度小于1:16者高,差异具有统计学意义(x2=13.536,P＜0.001).③新生儿梅毒感染情况:经随访,排除梅毒感染的新生儿中,规范治疗组占98.15％.规范治疗组与未规范治疗组、未治疗组间排除梅毒感染的新生儿比例比较差异有统计学意义(x2=26.119,P＜0.001);确诊感染梅毒的新生儿中,规范治疗组占1.11％,3组间比较差异有统计学意义(x2=22.234,P＜0.001).结论 淮安市近6年妊娠合并梅毒的发病率增长速度较快,应积极开展健康教育宣传,加强孕前及孕期梅毒筛查,同时规范抗梅毒治疗将有效改变孕妇不良妊娠结局,降低新生儿梅毒感染,保障母婴生存质量.%Objective To study the incidence trend of pregnancy complicated with syphilis in Huai' an City and to explore the effect of antisyphilitic treatment on pregnancy outcomes and neonatal syphilis infection.Methods Altogether 662 cases with syphilis in pregnancy in Huai' an City were collected from January 2011 to May 2016 and were recruited in a prospective study.Maternal age,gravidity,syphilis treatment status,pregnancy outcomes of pregnant women with syphilis and follow-up results of neonates for 0-18 months were analyzed.Results Average incidence of syphilis in pregnancy from 2011 to 2016 in Huai' an City was 1.94‰,with annual incidence of 0.50‰,1.94‰,2.23‰,2.30‰,2.71‰ and 2.06‰,respectively in six years.Difference in annual incidence was statistically significant (x2 =45.625,P ＜ 0.001),which showed a trend of increasing year by year.Analysis on 568 cases that already had pregnancy outcome revealed that difference in term birth rate in standard treatment group,non-standard treatment group and untreated group was statistically significant (x2 =26.926,P ＜ 0.001),and that term birth rate of patients with standard treatment was highest.Incidence of adverse pregnancy outcome of pregnant women with rapid plasma regain circle card test (RPR) initial titre more than 1:16 was higher than that in women with initial titre less than 1:16,and the difference was statistically significant (x2 =13.536,P ＜ 0.001).In terms of neonatal syphilis infection status,according to follow-up,98.15％ of newborns excluded with syphilis were from standard treatment group.There was statistical significance in difference in proportion of newborns without syphilis infection among standard treatment group,non-standard treatment group and untreated group (x2 =26.119,P ＜ 0.001).Only 1.11％ of neonates detected with syphilis was from standard treatment group,and difference among three groups had statistical significance (x2 =22.234,P ＜ 0.001).Conclusion Incidence of syphilis in pregnancy has increased quickly in recent 6 years in Huai' an City.Health education should be carried out.Syphilis screening before and in pregnancy should be strengthened.What' s more,standardized anti-syphilis treatment can alleviate adverse pregnancy outcomes effectively,reduce incidence of neonatal syphilis infection and assure maternal and ineonatal life quality.