妊娠期梅毒母婴阻断的干预时机

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1、妊娠期梅毒母婴阻断的干预时机作者：谭小平刘红桂熊海燕宁景春李毕华彭桂玉【摘要】目的探讨妊娠梅毒在不同时期驱梅治疗或未治疗的妊娠不良结局和先天梅毒的发生。方法将252例妊娠合并梅毒孕妇，根据筛查诊断和开始治疗的时间，分为4组：孕前治疗组102例;孕期治疗组77例，其中妊娠≤20周治疗组32例，妊娠>20周治疗组45例;未治疗组73例。比较各组之间不良妊娠结局、新生儿梅毒血清学检查阳性及有临床表现的新生儿先天梅毒的发生。结果不同治疗时间不良妊娠结局发生率，孕前治疗组为17.6%(18/102)，孕期治疗组3

2、2.5%(27/77)，未治疗组56.2%(41/73)，组间比较呈递增性，差异有统计学意义(P<0.01);不同临床表现不良妊娠结局发生率，潜伏期梅毒24.9%(43/173)，一期梅毒44.1%(15/34)，二期梅毒57.7%(26/45)，3组比较，差异有统计学意义(P<0.01);不同干预时间先天梅毒的发生率比较，孕前治疗组与妊娠≤20周治疗组差异无统计学意义(P>0.05)，孕前治疗组新生儿脐带血甲苯胺红实验阳性率及新生儿临床先天梅毒的发生率均低于妊娠>20周治疗组，而妊娠

3、>20周治疗组又明显低于未治疗组，差异有统计学意义(P<0.01)。结论妊娠梅毒在妊娠前和妊娠早期干预治疗能有效地降低不良妊娠结局和先天梅毒的发生率，早发现、早治疗是妊娠梅毒母婴阻断的关键措施，妊娠期产检发现梅毒可建议孕妇选择终止妊娠。11【关键词】妊娠梅毒;先天梅毒;干预时机　　【Abstract】ObjectiveToinvestigatetheoccurrenceofadversepregnantoutcomesandcongenitalsyphilisamongpregnantwomenw

4、ithsyphiliswhoweretreatedindifferentpeiriodsornottreated.Methods252pregnantwomenwithsyphilisweredividedintofourgroupsbasedonthetimeoftretment:pre-pregnancytreatmentgroup(102cases),earlypregnancytreatmentgroup≤20weeksofgestation,32cases),latepregnancytreatme

5、ntgroup>20weeksofgestation,45cases),andnon-tretmentgroup(73cases).Theincidencofadversepregnantoutcomeandcongenitalsyphiliswascomparedamongdifferentgroups.ResultsTheincidenceofadversepregnantoutcomeswas17.6%forpre-pregnancygroup,32.5%forpregnancytreatment

6、group(thecombinationofearlyandlatepregnancytreatmentgroups,becauseofnostatisticdifferencebetweenthesetwogroups),and56.2%fornon-tretmentgroup,andthedifferencewassignificantbetweenthethreegroups.Theincidenceofcongenitalsyphilis(theTRUsTpositiverateinneonatalc

7、ordbloodorneonatalcongenitalsyphiliswithclinicdiagnosis)wassignificantlylowerinthecombinedgroupofpre-pregnancytreatmentgroupandearlypregnancytreatment11groupthaninthelatepregnancygroup,andincidenceinthelatepregnancygroupwasmarkedlylowerthaninthenon-treatmen

8、tgroup.ConclusionThetreatmentofpregnantsyphilisinpre-pregnancyorearlypregnancyperiodcaneffectivelydecreasetheoccurrenceofadversepregnantoutcomesandcongenitalsyphilis.Earlydetectionandearlytreatmentarek