妊娠合并梅毒121例临床分析

目的:探讨妊娠梅毒对妊娠结局和围产儿预后的影响及驱梅治疗方案的选择。方法:根据妊娠期是否行全疗程抗梅毒治疗,将121例经血清学检查确诊的梅毒孕妇,分为治疗组(92例)及未治疗组(29例),比较两组孕妇的妊娠结局、围产儿预后、新生儿先天梅毒的发生情况以及不同抗梅毒药物治疗与先天梅毒的关系。结果:①妊娠结局:治疗组足月分娩率为92.4%,未治疗组仅为48.3%,两组比较,差异有统计学意义(P<0.05)。治疗组早产与死胎、死产、流产发生率分别为6.5%和1.1%,明显低于未治疗组的31.0%和20.7%,两组比较,差异有统计学意义(P<0.05)。②围产儿预后:治疗组分娩正常新生儿者占79.1%,未治疗组仅占20.9%,两组比较,差异有统计学意义(P<0.05)。治疗孕周与用药的关系显示,开始治疗的孕周越早,先天梅毒患儿发生率越低(P<0.05)。③不同治疗方案的效果:应用苄星青霉素治疗者先天梅毒儿发生率为15.2%,应用头孢曲松治疗者先天梅毒儿发生率为18.8%,两组比较,差异无统计学意义(P>0.05),阿奇霉素治疗组先天梅毒儿发生率为66.7%,与其他两组先天梅毒儿发生率比较,差异有统计学意义(P<0.05)。结论:对妊娠梅毒的患者,采取有效地、全程抗梅毒治疗是改善妊娠结局和围产儿预后的关键;早期筛查、早期治疗十分重要。

Clinical analysis on 121 pregnant women infected by syphilis

Objective:To explore the effect of syphilis during pregnancy on pregnant outcomes and perinatal prognosis,and the choice of therapies of anti-syphilis.Methods:121 pregnant women with syphilis diagnosed by serological assays were divided into two groups according to whether they accepted a full course anti-syphilis therapy: treated group(92 cases) and untreated group(29 cases).The pregnant outcomes,perinatal prognosis and the incidence of congenital syphilis were compared between the two groups.Results:①Pregnant outcomes: there was significant difference in term delivery rate between treated group(92.4%) and untreated group(48.3%)(P<0.05).The rates of premature birth,fetal intrauterine death,stillbirth and abortion in treated group were 6.5% and 1.1%,which were lower than those in untreated group(31.0% and 20.7%)(P<0.05).②Perinatal prognosis: there was significant difference in the proportion of normal neonates between treated group(79.1%) and untreated group(20.9%)(P<0.05).Gestational weeks and therapeutic effect showed that :the earlier the therapy started during pregnancy,the lower the rate of congenital syphilis was(P<0.05).③Comparison of the effects of three anti-syphilis drugs: there was no difference in the rate of congenital syphilis between benzathine penicillin group(15.2%) and ceftriaxone group(18.8%),but there was significant difference between azithromycin group(66.7%) and the other two groups(P<0.05).Conclusion:For pregnant women with syphilis,effective and full-course anti-syphilis therapy is the key to improving the pregnant outcomes,perinatal prognosis and reducing the incidence of congenital syphilis.Early screening and early treatment are very important.