妊娠梅毒患者的驱梅治疗及对围产结局的影响

目的:探讨妊娠期驱梅治疗的方法及对围产结局的影响。方法:选取89例妊娠期合并梅毒孕妇,依据确诊梅毒及首次注射首剂青霉素治疗时间分为3组,其中在妊娠早期(孕周≤12周)24例为早孕组,妊娠中期(12周<孕周<29周)31例为中孕组,妊娠晚期(孕周≥29周)34例为晚孕组,给予规范苄星青霉素或红霉素治疗,观察围产儿预后。结果:早孕组及中孕组产妇不良妊娠结局发生率分别为8.33%、19.35%,明显低于晚孕组(52.94%),差异具有统计学意义(P<0.05);89例孕妇根据初次检测RPR滴度不同分组,其中滴度≤1∶4者53例,滴度≥1∶8者36例,滴度≤1∶4者新生儿不良预后发生率为7.55%,明显低于滴度≥1∶8孕妇分娩的新生儿不良预后发生率(27.18%),差异具有统计学意义(P<0.05),先天性梅毒患病率分别为3.22%、22.77%,差异具有统计学意义(P<0.05);早孕组孕妇分娩新生儿RPR阳性率为20.83%,先天性梅毒患病率为0,中孕组分别为19.35%、3.23%,晚孕组分别为70.59%、26.47%,早孕组及中孕组RPR阳性率、先天性梅毒患病率明显低于晚孕组,差异具有统计学意义(P<0.05)。结论:妊娠合并梅毒孕妇采取驱梅治疗时机与围产儿的预后及先天性梅毒患病率密切相关,早期正规进行驱梅治疗能明显改善围产儿预后,降低先天性梅毒发生率。

Treatment for pregnant syphilis and its effect on perinatal outcome

Objective:To investigate the treatment for pregnant syphilis and its effect on perinatal outcome.Methods:A total of 89 pregnancy cases with syphilis were selected,and were divided into three groups according to diagnosis time and and time of first injection of penicillin:early trimester group 24 cases(gestational weeks ≤ 12 weeks),second trimester group(gestational weeks > 12 weeks but < 29 weeks) 31 cases,and late trimester group(gestational weeks ≥ 29 weeks) 34 cases.All patients were given benzathine penicillin or erythromycin,and the prognosis of perinatal infants were observed.Results:Incidence of adverse pregnancy outcome was 8.33%,19.35%,respectively in early trimester group and second trimester group,significantly lower than that of late trimester group(52.94%)(P<0.05);Out of 89 cases,there were 53 cases with titer ≤1∶4,36 cases with titer ≥1∶8.The incidence of poor prognosis was 7.55% in ≤1∶4 group,and significantly lower than that of ≥1∶8 group(27.18%)(P<0.05).The incidence of congenital syphilis were 3.22%,22.77% in two different titer groups,respectively,with significant difference between two groups(P<0.05);RPR positive rate was 20.83%,19.35% and 70.59% in three trimester groups,incidence of congenital syphilis was 0.00%,3.23% and 26.47%,respectively.RPR positive rate and incidence of incidence of congenital syphilis were significantly higher in late trimester group(P<0.05).Conclusions:The treatment time for pregnancy with syphilis is closely associated with the prognosis of perinatal infants dead and incidence of congenital syphilis.Early and effective treatment can obviously improve the prognosis of perinatal infants,and reduce the incidence of congenital syphilis.