[孕期梅毒母婴传播的干预方法及模式研究]

Zhang Rong-lian, Chen Qi-yan, Chen Lie-ping, Wang Xiu-yun, Zhang Li-ping, Xiu Xiao-yan, Yang Na, Bao Xiao-zhen

Department of Health Care, Fujian Provincial Maternal and Children's Health Hospital, Fuzhou 350001, China.

Zhonghua Fu Chan Ke Za Zhi. 2007 Jul;42(7):438-42.

OBJECTIVE

To explore the maternal-fetal transmission patterns and interventional methods of syphilis during pregnancy.

METHODS

A total of 847 cases of syphilis in pregnancy confirmed by rapid plasma reagin test (RPR) and treponema pallidum hemoagglutination test (TPHA) were treated with procaine benzylpenicillin intramuscular injection, and with erythrocin oral medication if hypersensitive to benzylpenicillin. Eight hundred forty seven cases of syphilis during pregnancy were followed up for pregnancy outcomes. And their newborn babies were tested using the RPR. The newborns with positive results were given intervention and followed up until 24 months after birth.

RESULTS

(1) A total of 733 cases among the total 847 have given birth to living-babies, in which 626 cases were tested using RPR, and the positive rate was 55.1% (345/626). (2) The RPR positive rate, neonatal mortality, preterm birth rate and low birth rate in the newborn of mothers with an RPR titer higher than or at 1:8 were higher than those of mothers with an RPR titer lower than 1:8 (P < 0.01). (3) The neonatal RPR positive rate was related to the timing of the treatment of the women. (1) The neonatal RPR positive rate was 22.4% (15/67) for treatment compared with 49.6% (330/666) for non-treatment before pregnancy (P < 0.01). (2) The positive RPR rate of neonates between treatment before pregnancy and treatment during pregnancy was different, being 22.4% (15/67) and 40.3% (240/595) respectively (P < 0.05) (3) In comparison between treatment both in the early pregnancy and in late pregnancy with only treatment in the late pregnancy, the positive RPR rate of neonates was 28.5% (45/158) and 56.9% (95/167) respectively (P < 0.01). In comparison between treatment both in the mid-term pregnancy and in late pregnancy and treatment in only one period in the terminal, the positive RPR rate of neonates was 37.0% (100/270) and 56.9% (95/167) respectively (P < 0.01).

CONCLUSIONS

The maternal-fetal transmission rate and perinatal prognosis are related to maternal RPR titer and the timing of maternal treatment. Inborn syphilis can be prevented and cured in fetal time. For neonates with anti-syphilis treatment in protestation, RPR positive rate is significantly lower than that without treatment in protestation. Treatment prior to pregnancy is a powerful measure to prevent the maternal-fetal transmission of syphilis.

目的

探讨妊娠期梅毒母婴传播模式及干预方法。

方法

对847例经快速血浆反应素试验（RPR）及梅毒螺旋体血凝试验（TPHA）确诊的妊娠期梅毒患者，采用普鲁卡因苄星青霉素肌内注射治疗，对青霉素过敏者口服红霉素治疗。对847例妊娠期梅毒患者进行妊娠结局随访，并对其新生儿进行RPR检测。对检测结果阳性的新生儿进行干预并随访至出生后24个月。

结果

（1）847例中共有733例分娩活婴，其中626例进行RPR检测，阳性率为55.1%（345/626）。（2）RPR滴度高于或等于1:8的母亲所生新生儿的RPR阳性率、新生儿死亡率、早产率及低体重率均高于RPR滴度低于1:8的母亲所生新生儿（P<0.01）。（3）新生儿RPR阳性率与孕妇治疗时机有关。（1）孕期未治疗者新生儿RPR阳性率为49.6%（330/666），孕期治疗者为22.4%（15/67）（P<0.01）。（2）孕前治疗与孕期治疗新生儿RPR阳性率不同，分别为22.4%（15/67）和40.3%（240/595）（P<0.05）。（3）孕早期及晚期治疗与仅晚期治疗相比，新生儿RPR阳性率分别为28.5%（45/158）和56.9%（95/167）（P<0.01）。孕中期及晚期治疗与仅晚期某一阶段治疗相比，新生儿RPR阳性率分别为37.0%（100/270）和56.9%（95/167）（P<0.01）。