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.

Impact of different treatment timing of syphilis during pregnancy on perinatal outcome

Objectives： To investigate the perinatal outcomes from different treatment timing of syphilis dur- ing pregnancy and analyze the impact on fetal prognosis. Methods： 119 pregnant women with syphilis in our hospi- tal between 2012.1.1 -2013.1.1 were selected as research objects and divided into treatment group （89 cases） and non - treatment group （30 cases） based on whether they had received treatment. Patients in the treatment group were divided into three subgroups, namely early pregnancy group （28 cases）, medium pregnancy group （32 cases） and late pregnancy group （29 cases） according to the treatment timing, which were before 12 gestational weeks, 13 28 gestational weeks, and above 29 gestational weeks. Follow - up of the entire perinatal period was conducted to understand perinatal outcomes of all patients, and analyze its impact on the fetal prognosis; meanwhile the maternal RPR titer and Apgar score of patients in the three groups were compared. Results： After treated with benzathine penicillin or erythromycin standardized drug treatment, the incidence of adverse perinatal outcomes of the three treatment subgroups were7.14% （2/28）, 21.88% （ 7/32 ） and 31.03 % （ 9/29 ） respectively; full - term delivery rates were 92.86% （26/28）, 78.12% （25/32） and 68.97% （20/29） respectively; incidence rate of syphilis in newborns were 0（0/28）, 15.63% （5/32） and 20.69% （6/29） respectively; in terms of neonatal Apgar score （lmin and 5min） and the maternal RPR titer, early pregnancy group was better than medium and late pregnancy group; and treatment group was obviously better than the non -treatment group in all aspects, with statistically sig- nificant difference （ P 〈 0.05 ）. Difference in the incidence rate of adverse perinatal outcome, full - term birth rate, neonatal syphilis incidence rate, neonatal Apgar score and maternal RPR titer between the three subgroups was statistically significant （ P 〈 0.05 ）. Conclusion： The principle of early de