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目的探讨妊娠合并梅毒被确诊时的血清滴度情况及治疗时机与出现不良妊娠结局的关系,以为降低不良妊娠结局的发生率提供参考。方法对2011年10月至2014年12月经血清学检查并确诊的115例妊娠合并梅毒患者的临床资料进行回顾性分析,根据妊娠期抗梅毒治疗的时机及是否抗梅毒治疗,将孕妇分为早孕中孕治疗组(<13孕周和13~28孕周开始治疗)、晚孕治疗组(>28孕周开始治疗)、未治疗组(入院时发现及产出先天梅毒儿后确诊),比较3组孕妇的妊娠结局,以及治疗时孕妇不同血清学滴度的妊娠结局。结果本研究115例中,足月产74例,早产30例,死胎11例。104例存活胎儿中,未治疗组、晚孕治疗组、早孕中孕治疗组的足月产率依次增高(58.8%、75.0%、100.0%),差异有统计学意义(P<0.01);未治疗组、晚孕治疗组、早孕中孕治疗组的先天梅毒儿发生率依次降低(45.6%、12.5%、0),差异有统计学意义(P<0.01)。在孕28周内开始抗梅毒治疗,即使孕妇血清TRUST滴度≥1∶16,亦无1例新生儿发生先天梅毒;而﹥孕28周开始治疗,则发生1例先天梅毒。在13孕周内开始抗梅毒治疗者,即使孕妇血清TRUST滴度≥1∶16,亦无1例死胎发生;13孕周以上开始治疗,则发生4例死胎。结论越早筛查确诊,越小孕周规范抗梅毒治疗,即使血清滴度很高,也能很好地改善妊娠结局;如未行规范治疗,即使血清滴度很低,也会产生不良妊娠结局。
Objective To investigate the relationship between the titer of serum and the timing of treatment and the outcome of adverse pregnancy in the diagnosis of syphilis with pregnancy in order to provide a reference for reducing the incidence of adverse pregnancy outcomes. Methods A retrospective analysis was performed on the clinical data of 115 cases of pregnancy complicated with syphilis who were serologically examined and confirmed from October 2011 to December 2014. According to the timing of anti-syphilis treatment during pregnancy and whether anti-syphilis treatment, pregnant women were divided into early pregnancy The second trimester treatment group (<13 weeks of gestation and 13-28 weeks of gestation), the second trimester (> 28 weeks of gestation), the untreated group (confirmed after admission and the birth of congenital syphilis) Pregnancy outcomes in 3 groups of pregnant women, as well as pregnancy outcomes of different serological titers of pregnant women during treatment. Results Of the 115 cases studied in this study, there were 74 full-term births, 30 preterm births and 11 stillbirths. Among the 104 surviving fetuses, the full-term monthly birth rate was significantly higher than that of the untreated group, the late pregnancy group and the second trimester pregnancy group (58.8%, 75.0%, 100.0%). The difference was statistically significant (P <0.01) The incidence of congenital syphilis in the treatment group, the late pregnancy treatment group and the second trimester pregnancy treatment group were successively lower (45.6%, 12.5%, 0), with statistical significance (P <0.01). In the first 28 weeks of pregnancy, anti-syphilis treatment started, even if pregnant women serum TRUST titer ≥ 1: 16, no neonatal congenital syphilis occurred; and> 28 weeks pregnant began treatment, then 1 case of congenital syphilis. In the 13th gestational week to start anti-syphilis treatment, even if the pregnant women serum TRUST titer ≥ 1:16, no one stillbirth occurred; more than 13 gestational weeks began treatment, the occurrence of 4 stillbirths. Conclusions The sooner the screening is confirmed, the smaller the gestational age standard anti-syphilis treatment, even if the serum titer is very high, but also can improve the pregnancy outcome; if not the standard treatment, even if the serum titer is very low, will produce adverse pregnancy ending.