妊娠期梅毒临床结局的相关因素分析及临床诊治

目的：分析影响梅毒患者妊娠结局的相关因素,探讨妊娠期梅毒的诊断与治疗方法,最大限度地提高新生儿结局。方法：选择我院2010年1月至2013年3月131例妊娠合并梅毒患者资料进行分析,其中82例孕产妇在产前经血清学筛查确诊后给予驱梅治疗,49例孕产妇于临产经输血前四项指标筛查确诊,未进行驱梅治疗,对两组产妇与新生儿结局进行分析,同时探讨妊娠期梅毒患者的诊治方法。结果：治疗组共发生新生儿先天性梅毒17例,发生率为20．73％;未治疗组共发生先天性梅毒29例,发生率为59．18％。治疗组死胎、早产发生率均低于未治疗组,流产发生率高于未治疗组,早孕组新生儿先天性梅毒发生率、死胎率、不良妊娠发生率明显低于晚孕组,流产、早产发生率高于晚孕组与中孕组,两组比较差异具有显著性（P〈0．05）。剖宫产组新生儿先天性梅毒感染40例,感染率为33．33％;阴道分娩组感染6例,感染率为54．55％,阴道分娩感染率明显高于剖宫产,两种分娩方式感染率比较差异具有显著性（P〈0．05）。结论：妊娠期梅毒是导致新生儿结局不良的危险因素,分娩方式、治疗时间及科学规范的驱梅治疗可提高新生儿结局。     

Screening for syphilis in arrestees: usefulness for community-wide syphilis surveillance and control

BACKGROUND: Syphilis screening of jail arrestees has been promoted as an effective method for both disease control and surveillance. GOALS: To evaluate the yield of the East Baton Rouge Parish Jail screening program in detecting previously undiagnosed syphilis, to evaluate the program as a means for monitoring community syphilis rates, and to characterize arrestees at greatest risk for syphilis infection. STUDY DESIGN: From July 1994 to December 1998, arrestees brought to the East Baton Rouge Parish Jail were screened for syphilis. Annual early syphilis prevalence in screened arrestees was calculated and compared with the annual period prevalence of early syphilis in the general population of East Baton Rouge Parish, as reported by laboratories and health providers. A case-control study of cases detected at the jail from 1995 to 1997 and contemporary controls was conducted. RESULTS: A total of 50,941 arrestees were booked into the East Baton Rouge Parish Jail, of whom 38,573 (76%) were screened for syphilis. Of the 38,573 arrestees screened, 494 (1.3%) were diagnosed with untreated syphilis. Of these, 299 (61%) were treated for syphilis before release. The estimated prevalence of early syphilis in arrestees decreased by 68% during the study period, from 0.79% in 1994 to 0.25% in 1998. During this time, the East Baton Rouge Parish community rates decreased by 79%, from 150 cases per 100,000 to 31 cases per 100,000. In female arrestees, a booking charge of prostitution was associated with syphilis (odds ratio [OR] 7.0; 95% CI, 1.5, 39.3). In male arrestees, a booking charge of felony theft was associated with syphilis (OR 4.8; 95% CI, 1.8, 13.8). However, only 15 (12%) of the early syphilis cases would have been detected if screening had been based on the booking charges found to be associated with syphilis in this study. CONCLUSIONS: Routine syphilis screening and treatment in jail settings is feasible and identifies many persons with syphilis. Monitoring of syphilis prevalence among arrestees is a useful method for monitoring community prevalence of syphilis. Analysis of booking charges may be useful for determining factors associated with syphilis infection, but not for developing screening criteria.     

苄星青霉素与阿奇霉素治疗妊娠期梅毒患者临床疗效及对新生儿影响的对比分析

目的:探究与分析阿奇霉素治疗妊娠期梅毒预防先天性梅毒的临床效果。方法:选取我院自2012年8月至2014年8月收治的80例妊娠期梅毒患者,采取随机数字表法分为苄星青霉素G组与阿奇霉素组,每组各40例,观察两组患者于不同用药方式下的临床效果。结果:苄星青霉素G组与阿奇霉素组在妊娠期治疗后快速血清反应素试验滴度下降2个稀释度及以上、下降1个稀释度、稀释度不变与上升1个稀释度的患者数相比无明显差异(χ2=1.37,P0.05;χ2=1.56,P0.05;χ2=1.25,P0.05;χ2=1.19,P0.05)。苄星青霉素G组与阿奇霉素组生产正常婴儿的有效率与无效率相比无明显差异(χ2=1.22,P0.05;χ2=1.07,P0.05)。结论:采用阿奇霉素对妊娠期梅毒预防先天性梅毒的临床疗效与苄星青霉素G无明显差异,提示二者在治疗妊娠期梅毒及在预防先天性梅毒方面具有相同的功效,对于青霉素皮试阳性的患者可采取阿奇霉素进行替代治疗。     

妊娠梅毒的孕期干预时机对妊娠结局的影响研究

目的:分析并探讨妊娠梅毒孕妇孕期干预时机对母婴妊娠结局的影响。方法:选取医院进行产检及分娩的孕妇254例,所有孕期发现梅毒后,均给予长效青霉素治疗。早期干预组给予240万U,臀部肌内注射,1次/周,3周/疗程。每疗程结束后复查,若转阴,则晚期再治疗1个疗程,若未转阴且RPR(快速血浆反应素环状卡片试验)滴度下降小于2倍比稀释度,则继续治疗1个疗程。对于中期干预者,在发现后治疗1个疗程,晚期治疗1个疗程。晚期干预者在发现后即治疗1个疗程。结果:早期干预组早产、低体重儿12例(10.00%),死胎0例,新生儿畸形0例,新生儿死亡0例,新生儿梅毒0例;中期干预组早产、低体重儿22例(26.83%),死胎2例(2.44%),新生儿畸形2例(2.44%),新生儿死亡0例,新生儿梅毒2例(2.44%);晚期干预组早产、低体重儿26例(50.00%),死胎8例(15.38%),新生儿畸形4例(7.69%),新生儿死亡4例(7.69%),新生儿梅毒10例(19.23%)。早期干预妊娠结局最优,且新生儿梅毒发生率最低(P0.05)。RPR滴度低组,妊娠结局明显优于滴度高组,且新生儿梅毒发生率低(P0.05)。结论:妊娠梅毒孕妇孕期早期干预有利于改善妊娠结局,降低新生儿先天梅毒发生率,临床上对疑似孕妇应尽早诊治。     

不同孕期治疗妊娠期梅毒对妊娠结局及新生儿梅毒感染情况的影响

目的:探讨不同孕期治疗妊娠期梅毒对妊娠结局及新生儿梅毒感染情况的影响。方法:选取2010年1月至2014年12月本院诊治的妊娠期梅毒患者80例,根据患者的治疗时间分为A组(孕期≤12周)、B组(孕期12~27周)、C组(孕期≥28周),三组患者均给予规范、足量的抗梅毒治疗。观察并记录三组患者妊娠结局、新生儿Apgar评分、母婴梅毒RPR滴度情况。结果:A组梅毒孕产妇的足月分娩率88.5%显著高于B组的55.6%及C组的55.6%(P0.05);A组梅毒孕产妇的早产率是11.5%显著低于B组33.3%及C组的37.0%(P0.05);三组孕产妇的流产、死胎、低体重儿发生率结果比较差异无统计学意义(P0.05)。A组新生儿Apgar评分显著高于B组、C组新生儿(P0.05);A组母婴梅毒RPR滴度均显著低于B组、C组母婴梅毒RPR滴度(P0.05)。结论:妊娠期梅毒孕产妇及早给予抗梅毒治疗,可以显著的提高患者的足月分娩率、降低早产率、改善妊娠结局,提高新生儿Apgar评分,降低先天性梅毒的发生几率。     

Occurrence of congenital syphilis after maternal treatment with azithromycin during pregnancy

OBJECTIVE: To evaluate the efficacy of azithromycin in preventing congenital syphilis. METHOD: Five pregnant women with syphilis who were allergic to penicillin were given azithromycin, 1 g daily orally or intravenously, in different hospitals. The duration of the therapy ranged from 1 day to 10 days. A second course of therapy was provided at 28 weeks gestation. The babies were given a physical examination and blood test for serum rapid plasma reagin test (RPR), treponema pallidum hemagglutination test (TPHA), and fluorescent treponemal antibody adsorption test (FTA-ABS-19-sIgM) within three months after birth. RESULTS: Five infants born to these mothers developed skin rashes. Four of the infants had hepatomegaly and one showed osteochondritis. The tests RPR, TPHA, and FTA-ABS-19-sIgM were positive. The RPR titers varied from 1:64 to 1:256 and the babies were diagnosed with congenital syphilis. They were successfully treated with penicillin. CONCLUSIONS: Successful therapy for syphilis during pregnancy demands maternal care as well as prevention or cure of congenital infection. The failure of azithromycin in preventing congenital syphilis in our report suggests that azithromycin should not be recommended as an alternative in treating syphilitic pregnant women or fetal syphilis.     

Leukocytoclastic vasculitis: another condition that mimics syphilis

Syphilis, a disease that in the past was associated with significant morbidity and lethality rates, has resurged in recent years principally as a consequence of changes in risk behavior. An epidemiological group that is commonly affected is the HIV-infected population. The characteristics of the disease and its progression may differ in these patients. The present report describes a case of an HIV-positive male patient, who developed florid secondary syphilis: in addition to syphilitic roseola, he also presented with bilateral panuveitis and involvement of the central nervous system. Investigation revealed the prozone phenomenon and histological examination of the skin lesions showed the presence of leukocytoclastic vasculitis. This finding is extremely rare and few cases have been documented.     

妊娠期梅毒患者的治疗时机对围产结局及围生儿预后的影响

目的：探讨临床上妊娠合并梅毒患者在不同治疗时机的围产结局,并分析对胎儿预后产生的影响.方法：以我院2012年1月1日至2013年1月1日期间收治的119例妊娠合并梅毒患者为调查研究对象,根据治疗与否将其分为治疗组和非治疗组,人数分别为89例和30例.同时根据患者接受治疗时机的不同将治疗组患者分为三个亚组,即早孕组、中孕组以及晚孕组,每组人数分别为28例、32例、29例,治疗的时机分别为孕周在12周以下、孕周在13～28周以及孕周在29周以上,三组患者在接受治疗之后,对整个围产期进行随访,了解所有患者的围产结局情况,并分析对胎儿预后产生的影响,同时比较三组患者的母婴RPR滴度及其Apgar评分.结果：对治疗组患者给予苄星青霉素或者是红霉素药物进行规范化治疗之后,围产不良结局发生率分别为7.14％ （2/28）,21.88％（7/32）,31.03％（9/29）;患者的足月分娩率分别为92.86％（26/28）,78.12％（25/32）,68.97％（20/29）;新生儿在梅毒的发生率上分别为0（0/28）,15.63％ （5/32）,20.69％（6/29）;在新生儿的Apgar评分（1min和5min）以及母婴RPR滴度上,早孕组要比中孕组和晚孕组更占优势,而治疗组与非治疗组各项情况相比,前者要明显的占据优势,差异具有统计学意义（P＜0.05）.三个治疗亚组患者在围产不良结局发生率、足月分娩率、新生儿梅毒发生率、新生儿的Apgar评分、母婴RPR滴度上均有显著差异,差异具有统计学意义（P＜0.05）.结论：临床上针对妊娠合并梅毒的产妇应该做到早发现和早治疗,这能够有效地降低新生儿梅毒发病率,同时促进胎儿的预后.     

妊娠合并梅毒孕期规范治疗后对新生儿梅毒血清学的影响

目的：对妊娠合并梅毒孕期规范治疗后新生儿梅毒血清学的变化特点及转归进行分析。方法：选取2011年1月至2013年1月间经孕期规范治疗的妊娠合并梅毒孕产妇150例,于孕妇产前l周进行RPR及TPPA试验,并对新生儿娩出3d后及以后定期进行梅毒血清学检查,对不同时间血清学转阴情况进行分析。结果：（1）150例新生儿中106例RPR、TPPA双阳性,44例单TPPA阳性。与TPPA单阳性母亲新生儿相比,RPR、TPPA双阳性母亲的新生儿RPR阳性比例较高（P〈0．05）。（2）随访中RPR、TPPA双阳性新生儿转阴高峰在出生后2个月,而TPPA单阳性新生儿转阴高峰为出生后6～12个月间。（3）孕妇产前RPR滴度越高,新生儿血清RPR转阴时间越长（P〈0．05）,而孕妇产前RPR滴度与新生儿TPPA转阴时间无关（P〈0．05）。新生儿出生时RPR滴度越高则新生儿转阴时间越长,滴度于1：1～1：4间的新生儿,TPPA转阴时间更长（P〈0．05）。结论：妊娠合并梅毒孕期规范治疗后所分娩新生儿的梅毒血清检查结果多呈阳性,且母亲RPR滴度越高的新生儿,其梅毒血清检测呈阳性的时间越长,但RPR均能转阴。     

7800例新生儿TPPA和TRUST检测

目的 探讨非梅毒螺旋体抗原血清学试验和梅毒螺旋体抗原血清学试验检测胎传梅毒的价值及其临床实用性。方法 对门诊及住院7800例新生儿用甲苯胺红不加热血清试验（TRUST）做非特异性抗体定量检测,梅毒螺旋体明胶颗粒凝聚集试验（TPPA）做特异性抗体定性检测。统计分析确诊的胎传梅毒患儿初次梅毒血清学试验结果。比较TPPA和TRUST试验的敏感度和特异性。结果 进行血清学筛查的7800例新生儿中,初次梅毒血清学检测TPPA（+）、TRUST（+）60例,其中胎传梅毒患儿15例;初次梅毒血清学检测TPPA（+）、TRUST（-）47例,其中胎传梅毒患儿5例。TRUST试验检测胎传梅毒的敏感率为75%（5/20）,特异性为99.41%（7734/7780）。TPPA试验检测胎传梅毒的敏感率为100%（20/20）,特异性为98.88%（7693/7780）。结论 TPPA比TRUST更适用于胎传梅毒的筛查。     

A study evaluating ceftriaxone as a treatment agent for primary and secondary syphilis in pregnancy

OBJECTIVES: To evaluate the efficacy of ceftriaxone in pregnant women who were diagnosed with early syphilis. STUDY: Eleven women with a history of penicillin allergy, positive skin test, but prior history of safe usage of cephalosporins were included. Ceftriaxone (250 mg) was given intramuscularly once daily for 7 and 10 days to patients with primary and secondary syphilis, respectively. A second course of therapy was provided at 28 weeks' gestation. The rapid plasma reagin test (RPR) was measured before and after therapy. The blood of neonates was also tested at delivery and during the follow-up period. RESULTS: The serum RPR titers of 11 mothers decreased fourfold, 3 months after treatment. Ten patients developed negative RPR results. The serum RPR was negative at delivery or 6 months after delivery in all neonates. CONCLUSIONS: Ceftriaxone may be considered as an alternative for treatment of early syphilis in pregnancy.