2013-2015年上海市孕产妇梅毒感染治疗现状及其不良妊娠结局相关因素分析

中华传染病杂志 Pub Date : 2019-04-15 DOI:10.3760/CMA.J.ISSN.1000-6680.2019.04.005

Yibin Gu, Yang Li, Liping Zhu, L. Du, Qi Zhao, Biao Xu

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引用次数: 1

摘要

目的分析上海地区梅毒孕妇梅毒治疗依从性及不良妊娠结局的相关因素。方法以上海市孕产妇梅毒监测系统为基础，建立前瞻性队列，纳入2013年1月至2015年12月诊断为梅毒的所有孕妇。在基线时，共招募了1717名患有梅毒的孕妇，其中1147人在治疗和怀孕期间接受了随访，并记录了分娩结果。收集了孕妇梅毒检测/治疗和婴儿健康结果的信息。卡方检验用于单因素分析，逻辑回归模型用于确定与梅毒治疗和不良妊娠结局相关的因素。结果共有685名受试者在妊娠期间接受了梅毒治疗，治疗率为59.7%，其中397名（34.6%）患者接受了两个疗程的完整治疗。受教育程度低、待业/待业或多胎人群对治疗的依从性较差。在妊娠晚期诊断的病例中，只有34.9%（142/407）接受了梅毒治疗，10.1%（41/407）完成了治疗。妊娠期接受梅毒治疗的受试者的非密螺旋体转化率高于未接受梅毒治疗者（39.1%[268/285]vs 3.7%[17/462]）。妊娠期完全梅毒治疗是降低新生儿死亡调整后相对风险（[aRR]=0.05，95%CI:0.0.01-0.37，P=0.003）和早产/低出生体重的保护因素（aRR=0.44，95%CI:0.27-0.70，P=0.001）。分娩前强阳性非密螺旋体检查结果增加了新生儿死亡的风险（aRR=12.89，95%CI:1.70-100.43，P=0.014）和早产/低出生体重的风险（a RR=12.78，95%CI:152-5.06，P=0.001，孕妇病史会影响妊娠期梅毒治疗的依从性。梅毒的早期诊断和完整的治疗过程可以改善妊娠结局和婴儿的健康状况。关键词：梅毒；母婴传播；治疗；不良妊娠结局

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Treatment status of maternal syphilis infection and factors associated with their adverse pregnant outcomes in Shanghai during 2013-2015

Objective To analyze the factors associated with syphilis treatment compliance and adverse pregnant outcomes among pregnant women with syphilis in Shanghai. Methods The prospective cohort was established based on maternal syphilis monitoring system of Shanghai, which included all the pregnant women diagnosed with syphilis during Jan 2013 to Dec 2015. A total of 1 717 pregnant women with syphilis were recruited at the baseline, and 1 147 of them were followed up during treatment and their pregnancy, and the delivery outcomes were recorded. The information of testing/treatment of pregnant women with syphilis and health outcomes of infants were collected. Chi-square test was used for univariate analysis and logistic regression model was used to identify the factors associated with syphilis treatment and adverse pregnant outcomes. Results A total of 685 participants received syphilis treatment during pregnancy, with the treatment rate of 59.7%. Among them, 397(34.6%) patients underwent two courses of complete treatment. The poor educated, unemployed/job-waiting or multipara population had poor compliance to treatment. Only 34.9% (142/407) of cases diagnosed at last trimester received syphilis treatment and 10.1%(41/407) completed the treatment. The proportion of non-treponemal conversion were higher in subjects who received syphilis treatment during pregnancy than those who did not (39.1%[268/285] vs 3.7%[17/462]). Complete syphilis treatment during pregnancy was protective factor to decrease neonatal death adjusted relative risk ([aRR]=0.05, 95%CI: 0.01-0.37, P=0.003) and prematurity/low birth weight (aRR=0.44, 95%CI: 0.27-0.70, P=0.001). Strong positive non-treponemal result before delivery increased the risks of neonatal death (aRR=12.89, 95%CI: 1.70-100.43, P=0.014) and prematurity/low birth weight (aRR=12.78, 95%CI: 152-5.06, P=0.001). Conclusions Factors such as educational level, employment status, and maternal history will affect the compliance of syphilis treatment during pregnancy. Early diagnosis and complete treatment course of syphilis could improve the pregnant outcomes and the health status of infants. Key words: Syphilis; Mother-to-child transmission; Treatment; Adverse pregnant outcome

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来源期刊

中华传染病杂志

自引率

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发文量

5280

期刊介绍： The Chinese Journal of Infectious Diseases was founded in February 1983. It is an academic journal on infectious diseases supervised by the China Association for Science and Technology, sponsored by the Chinese Medical Association, and hosted by the Shanghai Medical Association. The journal targets infectious disease physicians as its main readers, taking into account physicians of other interdisciplinary disciplines, and timely reports on leading scientific research results and clinical diagnosis and treatment experience in the field of infectious diseases, as well as basic theoretical research that has a guiding role in the clinical practice of infectious diseases and is closely integrated with the actual clinical practice of infectious diseases. Columns include reviews (including editor-in-chief reviews), expert lectures, consensus and guidelines (including interpretations), monographs, short monographs, academic debates, epidemic news, international dynamics, case reports, reviews, lectures, meeting minutes, etc.