抗梅毒治疗时机和梅毒TRUST滴度对梅毒孕妇妊娠结局的影响研究

目的:探讨抗梅毒治疗和梅毒TRUST滴度对梅毒孕妇妊娠结局的影响。方法:选取2013年5月至2015年9月我院收治的72例妊娠期梅毒患者作为观察组研究对象,选取60例同期健康孕产妇作为对照组,观察组根据治疗时机分为四组:A组(14例)在孕12周内予以驱梅治疗,B组(18例)在孕28周后予以治疗;C组(24例)整个孕期均进行驱梅治疗;D组(16例)孕期未给予驱梅治疗。比较两组及观察组不同治疗时机、TRUST滴度的妊娠结局和新生儿情况。结果:观察组早产、流产、死胎发生率及新生儿低出生体重、先天梅毒、死亡率均明显高于对照组,TRUST滴度≥1∶8时明显高于TRUST滴度<1∶8,差异有统计学意义(P<0.05);D组不良妊娠结局发生率(81.4%)明显高于A组(50.0%)、B组(55.6%)及C组(33.4%),差异有统计学意义(P<0.05);不良妊娠结局发生率大小依次为:D组>B组>A组>C组;A组新生儿情况明显好于B、C、D组,差异有统计学意义(P<0.05),C、B、D组次之。结论:抗梅毒治疗时机和梅毒TRUST滴度对梅毒孕妇妊娠结局及新生儿预后具有重要影响。     

不同滴度的妊娠梅毒患者的治疗结局分析

目的:探讨不同滴度的妊娠梅毒治疗后对治疗结局的分析。方法:回顾性分析2014年1月至2016年9月于我科治疗的120名妊娠梅毒患者作为本次试验的研究对象。将选取的120名妊娠梅毒患者根据妊娠梅毒确诊时的甲苯胺红不加热血清试验(TRUST滴度)的不同分为三组:分别为妊娠梅毒确诊时TRUST滴度小于1∶4、妊娠梅毒确诊时TRUST滴度1∶4~1∶8、妊娠梅毒确诊时TRUST滴度1∶8以上。TRUST滴度小于1∶4组患者30例,TRUST滴度1∶4~1∶8组患者50例,TRUST滴度1∶8以上组患者40例。然后对各组患者的妊娠结局进行统计学分析。结果:TRUST滴度<1∶4组自然流产1例(3.3%)、宫内死胎1例(3.3%)、早产儿2例(6.7%)、新生儿先天性梅毒1例(3.3%),不良妊娠结局的发生率为16.7%;TRUST滴度1∶4~1∶8组自然流产5例(10%)、宫内死胎3例(6%)、早产儿5例(10%)、新生儿先天性梅毒5例(10%),不良妊娠结局的发生率为36%;TRUST滴度>1∶8组自然流产5例(12.5%)、宫内死胎4例(10%)、早产儿8例(20%)、新生儿先天性梅毒7例(17.5%),不良妊娠结局的发生率为60%。结论:妊娠梅毒不同滴度的患者治疗结局不同,妊娠梅毒滴度越高不良妊娠结局的发生率越高。     

422例终止妊娠的梅毒患者既往随访结果分析

目的:对深圳市宝安区终止妊娠的梅毒患者的随访结果进行分析,为有针对性地开展梅毒预防与控制工作提供依据。方法:收集宝安区终止妊娠的422例梅毒患者的相关资料,并进行回顾性分析。结果:422例终止妊娠的梅毒患者中20~35岁女性357例(84.60%);经婚前性传播者194例(45.97%),婚内性传播81例(19.19%),婚外性传播32例(7.58%);潜伏梅毒321例(76.07%);422例终止妊娠的梅毒患者中人工流产者187例(44.31%),其中初筛TRUST滴度≤1∶4者129例(30.57%);自然流产者35例(8.29%),其中初筛TRUST滴度≤1∶4者22例(5.21%);死胎死产者63例(14.93%),其中初筛TRUST滴度≥1∶8者53例(12.56%);异位妊娠者137例(32.46%),其中初筛TRUST滴度≤1∶4者106例(25.12%)。378例患者(89.57%)在孕28周之前进行梅毒筛查,其中352例患者(83.41%)选择苄星青霉素治疗。69.43%的患者6个月后就失访,极少数(1.9%)终止妊娠的梅毒患者随访到两年。结论:加强梅毒孕产妇的管理对降低梅毒患者终止妊娠发生率有重要意义。     

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。     

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。     

妊娠期梅毒患者妊娠结局及其影响因素分析研究

目的：研究观察妊娠期梅毒患者妊娠结局及其影响因素。方法：选取2009年1月至2014年3月本院收治的35例妊娠期梅毒患者为观察组,并以同期的35例健康孕产妇为对照组,然后将两组的妊娠结局及新生儿情况进行统计及比较,同时比较观察组中不同治疗时间及TRUST滴度者的妊娠结局及新生儿情况。结果：观察组的足月分娩率显著低于对照组,早产率、死胎率和流产率均高于对照组,新生儿情况也明显差于对照组。同时观察组中治疗时间较晚及未接受治疗者TRUST滴度≥1：8,患者的妊娠结局及新生儿情况明显差于早期接受治疗及TRUST滴度〈1：8者,P均〈0．05,均有显著性差异。结论：妊娠期梅毒患者妊娠结局相对较差,且治疗时间及TRUST滴度对其最终的妊娠结局及新生儿情况均影响较大,应重视对妊娠期梅毒患者的早期治疗。     

1388例老年梅毒患者梅毒抗体检测结果分析

目的回顾性分析第四军医大学西京皮肤医院老年梅毒患者的血清学检验资料,探讨老年患者梅毒的血清学特征,为临床老年梅毒的检测及防治提供参考依据。方法选取2010年12月至2019年12月第四军区大学西京皮肤医院门诊通过梅毒血清学检验首次考虑为梅毒、年龄≥60岁老年患者1 388例,回顾性分析其临床资料和梅毒血清学检验结果并进行总结。结果男性769例(55.40%)多于女性619例(44.60%),以60～64岁年龄段居多。患者来源于门诊1 173例,来源于住院患者215例。868例(62.54%)的患者是因住院或术前发现,主动就诊率低。1 388例患者中甲苯胺红不加热血清试验(TRUST)阴性患者402例(28.96%),TRUST滴度1∶8患者比例高于滴度≥1∶8患者,差异具有统计学意义(P0.01)。577例(41.57%)患者经人类免疫缺陷病毒(HIV)筛查,阳性15例(2.60%)。431例(31.05%)患者定期复查,其中经过规范驱梅治疗并随访2年及以上者达92例,TRUST滴度不变者76例(82.61%),TRUST转阴4例(4.35%), TRUST滴度下降4倍及以上者10例(10.87%),TRUST滴度上升4倍及以上者2例(2.17%)。86例(6.20%)患者行脑脊液的TRUST和梅毒螺旋体血凝试验(TPPA)检测,两者均阴性57例(66.28%),TRUST阴性TPPA阳性17例(19.77%),TRUST阳性TPPA阳性12例(13.75%),临床最后诊断为神经梅毒31例(36.05%)。结论老年梅毒患者以TRUST低滴度为主,随访后发现滴度不变者最多,考虑此类患者就诊时即为血清固定梅毒患者。老年患者主动就诊率低,多为术前筛查发现,定期复诊率、脑脊液检查率均较低,临床医师应重视老年患者梅毒及神经梅毒的实验室检查。     

早期梅毒患者血清甲苯胺红不加热血清试验滴度与神经梅毒发生的相关性分析

目的 分析早期梅毒患者血清甲苯胺红不加热血清试验(TRUST)滴度与神经梅毒发生的相关性。方法 选取2016年1月至2020年12月广西医科大学第一附属医院收治的103例早期梅毒患者作为研究对象,根据后期病情发展分为神经梅毒组(n=51)和非神经梅毒组(n=52)。对两组患者进行实验室检测,并开展统计学比较。结果 103例早期梅毒患者行梅毒血清学检测,血清TRUST滴度≥1∶32共有36例,其中神经梅毒组30例(58.8%),非神经梅毒组6例(11.5%),两组比较差异具有统计学意义(P=0.000)。对神经梅毒组患者的脑脊液检测结果进行分析,梅毒螺旋体颗粒凝集试验(TPPA)阳性患者50例,TRUST阳性患者33例,蛋白量升高患者27例,白细胞计数升高患者29例,脑脊液蛋白量和白细胞计数均升高患者15例;当确诊神经梅毒患者的脑脊液检测结果为阳性/异常时,其梅毒早期血清学TRUST滴度≥1∶32的占比偏高。结论 早期梅毒血清TRUST滴度≥1∶32的患者神经梅毒发生风险高,因此针对这类患者应尽早接受脑脊液检测并积极接受相关治疗,避免病情进一步发展。     

梅毒孕妇驱梅治疗对新生儿血清RPR结果的影响

目的探讨梅毒孕妇不同孕期开始驱梅治疗对新生儿血清RPR结果的影响。方法结构式问卷收集孕妇人口学资料,妊娠早、中、晚期首诊者检测血清梅毒抗体,TPPA和RPR双阳性者,以RPR 1∶4为界,将孕妇分为A(孕妇RPR≤1∶4)、B(RPR≥1∶8)两组,按方案统一给予苄星青霉素规范驱梅治疗,新生儿出生后进行血清RPR检测。结果共有梅毒孕产妇201例及其新生儿202例,其中A组180例,B组21例。治疗结果显示:同样孕早期起始治疗者,A组新生儿RPR阳性率显著低于B组,差异有统计学意义(P0.05);而孕中期、孕晚期开始治疗者,A、B两组新生儿RPR阳性率差异均无统计学意义(P0.05)。RPR≤1∶4的孕产妇,孕早期、孕中期起始治疗,其新生儿RPR阳性率差异无统计学意义(P0.05),但均低于晚期起始治疗者(P0.05)。而RPR≥1∶8的孕产妇,不同孕期起始治疗,其新生儿RPR阳性率差异亦无统计学意义(P0.05)。结论对于RPR≤1∶4的梅毒孕妇,影响新生儿RPR阳性率的是起始治疗时间,而不是孕妇RPR滴度水平。     

Skin in pregnancy

Screening for skin and sexually transmitted diseases was undertaken in 170 pregnant women in all the trimesters of pregnancy. Pruritus was the commonest presenting symptom (58.82%). Candidiasis (21.78%) was the commonest cause of white discharge per vagina, Condylomata acwninata (4.70%) was the commonest sexually transmitted disease. Three patients (1.76%) were seropositive for HIV infection. The commonest dermatological disorder observed was scabies (17.64%) while 48 other diseases accounted for less than 10% each.     

Syphilis in pregnancy

Syphilis can seriously complicate pregnancy and result in spontaneous abortion, stillbirth, non-immune hydrops, intrauterine growth restriction, and perinatal death, as well as serious sequelae in liveborn infected children. While appropriate treatment of pregnant women often prevents such complications, the major deterrent has been inability to identify the infected women and get them to undergo treatment. Screening in the first trimester with non-treponemal tests such as rapid plasma reagin (RPR) or venereal disease research laboratory (VDRL) test combined with confirmation of reactive individuals with treponemal tests such as the fluorescent treponemal antibody absorption (FTA-ABS) assay is a cost effective strategy. Those at risk should be retested in the third trimester. Treatment during pregnancy should be with penicillin. In determining a penicillin regimen, the clinician must consider the stage of the maternal infection and the HIV status of the mother. Patients who are allergic to penicillin should be desensitized before treatment. Despite appropriate treatment, as many as 14% will have a fetal death or deliver infected infants. Treatment may further be complicated by the Jarich-Herxheimer reaction, a complex allergic response to antigens released from dead micro-organisms, which can cause fetal distress and uterine contractions. Thanks to effective intervention strategies and inexpensive penicillin, syphilis rarely complicates pregnancy in the Western world today. In parts of the world where the traditional sexually transmitted diseases have not been controlled, the magnitude of problems associated with syphilis during pregnancy is reminiscent of that faced by the West during the early 1900's.     

Neurofibromatosis in pregnancy

Eleven pregnant patients with neurofibromatosis have been studied. They have had twenty-four pregnancies. Ten of these patients developed hypertension during their confinements. In the eleventh patient records were inadequate for analysis. In five of the ten patients, lesions of neurofibromatosis appeared for the first time during pregnancy. In the others the lesions increased in size and number. The lesions regressed considerably after delivery. It would seem that the hypertension during these pregnancies is more than a chance association.     

妊娠期血红蛋白浓度与妊娠结局相关性分析

目的:分析研究妊娠期母体高浓度血红蛋白与妊娠结局的相关性。方法:在2013年12月至2015年12月两年间来恩施土家族苗族自治州中心医院和湖北省妇幼保健院进行分娩的孕妇中,选取妊娠期在28周以上的单胎妊娠孕妇1374例。按照孕妇体内血红蛋白浓度的差异分为四组:血红蛋白浓度在75%以上者作为1组,50%~75%之间为2组,3组25%~50%,4组浓度在25%以下。统计分析血红蛋白浓度差异与妊娠结果的相关性。结果:通过对1374例研究对象记录的分析,四组孕妇孕早期血红蛋白浓度与妊娠结局无相关性(P0.05)。孕中晚期四组研究对象妊娠结局差异明显(P0.05),1、2组妊娠结局出现了更多不良情况。孕中期四组血红蛋白浓度分别为138g/L以上、130~138 g/L、123~129 g/L、123 g/L以下。孕晚期四组血红蛋白浓度分别为135 g/L以上、127~134 g/L、119~126 g/L以上、119 g/L以下。孕中期血液粘度4.50与≥4.50两组间无显著差异(P0.05)。与正常妊娠相比,孕晚期高血液粘度所造成的不良妊娠结局显而易见(P0.05)。结论:妊娠期母体内高浓度血红蛋白是造成不良妊娠结局的风险因素,应引起相关工作者与研究者的重视,及早记录、及早举措,保证母婴远离病患。     

Demodex folliculorum in pregnancy

BACKGROUND: Demodex folliculorum (DF), which is a resident in human pilosebaceous follicles, has been implicated in rosacea, blepharitis, pityriasis folliculorum, pustular folliculitis, and skin lesions of immunosuppressed patients on chemotherapy or with acquired immunodeficiency syndrome (AIDS). OBJECTIVE: We aimed to determine the influence of pregnancy on the carriage of DF. METHODS: Mite density in 40 pregnant women was compared with that of age- and sex-matched controls. Two standardized skin surface biopsies were taken from each subject. Results In pregnant women, DF was found at 0.55/cm2, compared with a mean value of 1.2/ cm2 in nonpregnant controls. The difference between the two groups was not statistically significant (Mann-Whitney test, P = 0.22). CONCLUSIONS: Our findings indicate that pregnancy may not have a direct effect on mite density.     

Dermatologic drugs in pregnancy

Since the thalidomide disaster, there has been increasing concern about the association of therapeutic agents with teratogenicity. Although teratogenicity of thalidomide is now well defined,¹ use of the drug is considered safe in nonpregnant patients and has proven useful in the treatment of leprosy reactions and a variety of skin diseases.^2,3 Nevertheless, association with birth defects resulted in removal of the drug from the market, which has made it virtually unavailable. Twenty years after the thalidomide disaster, association of the use of 13-cis-retinoic acid in pregnancy with a well-defined syndrome of birth defects has renewed concerns about the teratogenic risk of all drugs in pregnancy.⁴     

Dermatomyositis presenting in pregnancy

Summary We report the onset of dermatomyositis in a woman pregnant 38-weeks who subsequently delivered a healthy infant. The disease improved rapidly following delivery. The association of dermatomyositis with pregnancy is unusual, and fetal outcome may be adversely affected.