【摘要】 目的 分析妊娠期梅毒感染的治疗方案及治疗时机对妊娠结局的影响。方法 2013年1月至2018年12月期间，在陕西省榆林市靖边县人民医院、靖边县妇幼保健院和靖边县中医医院首次产前保健时接受免费梅毒筛查的孕妇有36 562名，其中确诊为妊娠期梅毒感染者151例。按治疗方案将其分为未治疗组(46例)与治疗组(105例);排除2例因青霉素过敏而选用头孢曲松进行治疗的患者，将103例患者分为规范治疗组(40例)与未规范治疗组(63例);按治疗时机将其分为妊娠≤20周组(76例)与妊娠>20周组(27例)。通过随访母婴围产结局，对抗梅毒治疗方案及治疗时机进行比较，并对结果进行统计分析。结果 有36 562名孕妇在首次产前保健时接受了梅毒血清学检测，其中151例确诊为梅毒感染，感染率为0.41%,潜伏期梅毒139例(92.05%)。在103例接受苄星青霉素治疗的患者中，规范治疗者40例(38.83%),未规范治疗者63例(61.17%)。规范治疗、未规范治疗和未治疗患者的不良妊娠结局发生率分别为2.50%(1/40)和22.22%(14/63)及52.17%(24/46)。未治疗组不良妊娠结局发生率明显高于治疗组(χ~2=23.28,P<0.01);规范治疗组不良妊娠结局发生率明显低于未规范治疗组(χ~2=7.45,P<0.01);妊娠>20周组启动治疗不良妊娠结局发生率明显高于妊娠≤20周组(χ~2=17.40,P<0.01);首次抗梅毒治疗的快速血浆反应素环状卡片试验(RPR)滴度≥1∶8,不良妊娠结局发生率明显高于RPR滴度≤1∶4(χ~2=14.15,P<0.01)。结论 妊娠期梅毒感染以潜伏期居多；早期规范治疗可减少不良妊娠结局的发生。更多还原

【Abstract】 Objective To analyze the effect of treatment plan and treatment timing on pregnancy outcome for syphilis infection during pregnancy.Methods Between January 2013 and December 2018,36 562 pregnant women received free syphilis screening at their first antenatal care at Jingbian County People′s Hospital, Jingbian County Maternal and Child Health Hospital, and Jingbian County Traditional Chinese Medicine Hospital in Yulin City, Shaanxi Province were included.Among them, 151 cases were diagnosed as syphilis infection during pregnancy.According to the treatment plan, they were divided into the untreated group(46 cases) and the treatment group(105 cases).2 patients who were treated with ceftriaxone due to penicillin allergy were excluded, and 103 patients were divided into the standardized treatment group(40 cases) and the unstandardized treatment group(63 cases).According to the timing of treatment, they were divided into gestational age≤20 weeks group(76 cases) and gestational age>20 weeks group(27 cases).The maternal and infant perinatal outcomes were followed up.The treatment regimen for syphilis and treatment timing were compared, and the results were statistically analyzed.Results Among 36 562 pregnant women who received syphilis serological testing at the first antenatal care, 151 cases were diagnosed with syphilis infection, the infection rate was 0.41%,and 139 cases(92.05%) were latent syphilis.Among the 103 patients who received benzathine penicillin treatment, 40 patients(38.83%) received standardized treatment, and 63 patients(61.17%) received unstandardized treatment.The incidence of adverse pregnancy outcomes in patients with standardized treatment, unstandardized treatment and untreated patients were 2.50%(1/40),22.22%(14/63) and 52.17%(24/46),respectively.The incidence of adverse pregnancy outcomes in the untreated group was significantly higher than that in the treatment group(χ~2=23.28,P<0.01).The incidence of adverse pregnancy outcomes in the standardized treatment group was significantly lower than that in the unstandardized treatment group(χ~2=7.45,P<0.01).The incidence of adverse pregnancy outcomes in the gestation>20 weeks group was significantly higher than that in the gestation≤20 weeks group(χ~2=17.40,P<0.01).For the first anti-syphilis treatment, the rapid plasma reagin ring card test(RPR) titer≥1:8,the incidence of adverse pregnancy outcomes was significantly higher than that with the RPR titer≤1:4(χ~2=14.15,P<0.01).Conclusion Syphilis infection during pregnancy is mostly latent syphilis.Early standardized treatment can reduce the occurrence of adverse pregnancy outcomes.更多还原