2015—2020年湖北省新生儿先天梅毒患病现状及其影响因素分析

  目的  了解湖北省梅毒感染孕产妇的流行病学特征及所娩儿童先天梅毒的患病情况，探讨发生先天梅毒的相关影响因素。  方法  收集2015年1月1日—2020年12月31日湖北省预防艾滋病、梅毒和乙型肝炎(简称乙肝)母婴传播管理信息系统中报告的梅毒感染孕产妇的个案信息，对其人口学特征、梅毒的检测治疗情况和所娩儿童先天梅毒的患病情况进行分析。采用多因素logistic回归分析模型分析发生先天梅毒的影响因素。  结果  3 467例梅毒感染孕产妇的年龄为(29.79±5.43)岁，母婴传播率为3.17%(110例)，接受过驱梅治疗的比例为73.35%(2 543例)，规范治疗的比例为49.21%(1 706例)，接受预防性治疗的梅毒暴露儿童占74.82%(2 594例)。多因素分析结果显示，产时/产后确诊梅毒感染(OR=1.879, 95% CI:1.237~2.853)、丈夫/性伴感染梅毒(OR=3.762, 95% CI:1.473~9.608)、妊娠末次非梅毒螺旋体血清学试验(简称非梅试验)效价≥1∶8(OR=8.908, 95% CI:1.840~43.131)、未进行治疗(OR=6.360, 95% CI:3.316~12.199)、进行一般治疗(OR=4.714, 95% CI:2.385~9.320)、暴露儿童接受预防性治疗(OR=0.559, 95% CI:0.369~0.846)和足月产(OR=0.496, 95% CI:0.300~0.821)是影响先天梅毒发病的独立因素(均有P＜0.05)。  结论  梅毒感染孕产妇的确诊时期、妊娠末次非梅试验效价、治疗情况、分娩孕周、丈夫/性伴梅毒感染状况和暴露儿童预防性治疗情况与先天梅毒的发生密切相关。早期明确诊断并规范开展驱梅治疗和暴露儿童预防性治疗有助于降低先天梅毒的发生。

Morbidity and influencing factors of congenital syphilis in newborns in Hubei of China, 2015-2020

  Objective  To investigate the epidemiological characteristics of pregnant women with syphilis and the prevalence of congenital syphilis in their children in Hubei Province, and to explore the related influencing factors of congenital syphilis.  Methods  Data of syphilitic pregnant women was collected from the national integrated prevention of mother-to-child transmission of HIV, syphilis, and HBV information management system from January 1, 2015, and December 31, 2020. The demographic characteristics, detection and treatment of syphilis, and the prevalence of congenital syphilis were analyzed. A multiple logistic regression model was used to analyze the influencing factors of congenital syphilis.  Results  The average age of 3 467 syphilis-infected pregnant women was (29.79±5.43) years old, and the rate of mother-to-child transmission was 3.17% (110 cases). About 73.35% (2 543 cases) had received antisyphilitic treatment, 49.21% (1 706 cases) had received standard treatment, and 74.82% (2 594 cases) of children exposed to syphilis received preventive treatment. Multivariate analysis showed that the parturition or postpartum period of syphilis was diagnosed (OR=1.879, 95% CI: 1.237-2.853), the status of syphilis infection of husband/sexual partner (OR=3.762, 95% CI: 1.473-9.608), non-treatment (OR=6.360, 95% CI: 3.316-12.199), nonstandard treatment (OR=4.714, 95% CI: 2.385-9.320), the last non-treponema pallidum antigen serologic test result≥1∶8 (OR=8.908, 95% CI: 1.840-43.131), preventive treatment for exposed children (OR=0.559, 95% CI: 0.369-0.846) and term birth (OR=0.496, 95% CI: 0.300-0.821) were independent factors affecting the prevalence of congenital syphilis (all P < 0.05).  Conclusions  The incidence of congenital syphilis was closely related to the diagnosis period of syphilitic pregnant women, the non-treponema pallidum antigen serologic test result at the last test during pregnancy, treatment condition, the gestational age of delivery, the status of syphilis infection of husband/sexual partner and preventive treatment condition of exposed children. Early diagnosis, standardized treatment and preventive treatment of exposed children were beneficial to reduce the occurrence of congenital syphilis.