妊娠梅毒孕期内和妊娠前抗梅毒治疗对分娩结果的影响  

Effect of Treatment of Syphilis During Pregnancy and Pre-pregnancy on Pregnant Outcome

作　　者：朱慧兰[1] 谷进[2] 苏向阳[3] 赖维[3] 

机构地区：[1]广州市皮肤病防治所性病妇科,广东广州510095 [2]中山大学附属三院妇产科 [3]中山大学附属三院皮肤科,广东广州510630

出　　处：《中山大学学报（医学科学版）》2006年第2期200-202,共3页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技厅重点攻关项目(2003C34203;2005B34201018);广州市卫生局基金资助项目(2005-YB-127)

摘　　要：【目的】探讨妊娠梅毒孕期内和妊娠前抗梅毒治疗对分娩结果的不同影响。【方法】将梅毒孕妇按其发现和治疗时间是在妊娠期内还是妊娠期前分为观察Ⅰ组与观察Ⅱ组,观察Ⅰ组是在妊娠时发现梅毒进行正规的青霉素抗梅毒治疗,观察Ⅱ组是已接受正规青霉素治疗后才怀孕。【结果】观察Ⅰ组165例中,9例Ⅰ期梅毒患者治疗均成功分娩产出活婴,14例Ⅱ期梅毒患者治疗成功11例,142例潜伏梅毒患者治疗成功136例;各期梅毒患者总的治疗成功率94.5%(156/165)。观察Ⅰ组经过足量治疗后所生新生儿中,梅毒血清阳性率为20.6%(34/165),其中6例患儿快速血浆反应素试验(RPR)滴度高于母亲的4倍;观察Ⅱ组174例所生新生儿中,梅毒血清阳性率为2.87%(5/174),但RPR滴度均低于母亲;两组比较差异有显著性(χ2=26.16,P﹤0.005)。观察Ⅰ组新生儿先天梅毒发生率为3.64%(6/165),给予青霉素驱梅治疗,跟踪随访2年先天梅毒均治愈;观察Ⅱ组新生儿先天梅毒发生率为0.57%(1/174),跟踪随访2年RPR滴度均阴转。差异有显著性(χ2=3.93,P﹤0.05)。【结论】妊娠梅毒不良结局高于妊娠前进行驱梅治疗的孕妇,对女性性病患者进行梅毒血清学筛查和对梅毒孕妇进行及时有效规范的治疗,可减少其所分娩新生儿发生先天梅毒。[Objective] To investigate the effect of treatment of syphilis during pregnancy and pre-pregnancy on pregnant outcome. [Methods] The patients with pregnant syphilis were divided into group Ⅰ and group Ⅱ according to whether they received penicillin anti-syphilis treatment or not before pregnancy. The group Ⅰ was diagnosed and treated after the pregnancy, group Ⅱ was cured before pregnancy. [Results] Of 165 patients with pregnant syphilis from Gynecological and Obstetrical Department, 9 cases with primary syphilis were cured, 11 of 14 patients with secondary syphilis and 136 of 142 patients with late syphilis were cured, the total cure rate in 165 patients was 94.5% （156/165）. Of 165 patients in group Ⅰ , by the syphilitic serological test, 34 cases （20.6%） were serum positive. Of 174 patients in group Ⅱ, 5 cases（2.87%） were serum positive. The positive rate of group Ⅰ was higher than that of group Ⅱ （x^2= 26.16, P〈 0.005）. Of 34 neonates with rapid plasma reagin （RPR） positive in group Ⅰ, their RPR titer was 4 times higher than that of their mothers in 6 cases, 5 cases in group Ⅱ were found not higher in titer but higher in X-ray,the positive rate of group Ⅰ was higher than that of group Ⅰ（x^2=3.93, P 〈 0.05）. [Conclusion] Syphilis increases the risk of adverse outcomes in pregnancy. Screening of syphilis and timely effective penicillin treatment during pregnant women and women sexual workers is necessary, and may reduce the incidences of congenital syphilis.

关 键 词：妊娠梅毒 先天梅毒 治疗 

分 类 号：R714.251[医药卫生—妇产科学] R759.1[医药卫生—临床医学]