南通市2012年至2019年孕妇人群梅毒筛查和治疗对预防梅毒宫内传播的效果  

Effect of screening and treatment of syphilis among pregnant women on prevention of intrauterine syphilis transmission in Nantong City,2012-2019

作　　者：娄海琴[1] 许碧云[2] 葛晓云[1] 刘维韦 施月琴[1] 吴佳聪[1] 周乙华[3] Lou Haiqin;Xu Biyun;Ge Xiaoyun;Liu Weiwei;Shi Yueqin;Wu Jiacong;Zhou Yihua(Department of Mass Health Care,Nantong Maternal and Child Health Hospital,Nantong 226018,China;Department of Biostatistics,Nanjing Drum Tower Hospital,Nanjing University Medical School,Nanjing 210008,China;Departments of Laboratory Medicine and Infectious Diseases,Nanjing Drum Tower Hospital,Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南通市妇幼保健院群体保健科,226018 [2]南京大学医学院附属鼓楼医院医学统计中心,210008 [3]南京大学医学院附属鼓楼医院科研部、感染科,210008

出　　处：《中华围产医学杂志》2021年第8期576-583,共8页Chinese Journal of Perinatal Medicine

基　　金：江苏省妇幼健康科研项目(F201828)。

摘　　要：目的我国自2011年起全面启动预防梅毒宫内传播策略,本研究旨在评估2012年至2019年江苏省南通市预防梅毒宫内传播的效果。方法纳入2012年1月1日至2019年12月31日江苏省南通市所有具有活产分娩结局的455561例孕妇为研究对象,回顾性分析梅毒筛查率和感染率、孕妇梅毒治疗情况,以及其宫内感染率和结局。采用趋势χ^(2)检验、校正χ^(2)检验或Fisher精确概率法等对数据进行统计分析。结果(1)455561例孕妇中,除3例外,另455558例(100.0%)筛查梅毒抗体,其中产前筛查率96.4%(439125/455561),分娩时筛查3.6%(16433/455561)。(2)796例(0.17%)确诊孕期梅毒,梅毒感染率由2012年的0.13%(85/64229)升至2019年的0.24%(110/45517)(χ^(2)_(趋势)=48.985,P<0.001);分娩时筛查孕妇梅毒感染率(0.50%,82/16433)高于产前筛查者(0.16%,714/439125)(χ^(2)=102.769,P<0.001)。(3)796例孕期梅毒孕妇中,716例(89.9%)进行了驱梅治疗(青霉素类695例,头孢曲松16例,红霉素或阿奇霉素5例),80例(10.1%)未治疗。共发生梅毒宫内传播14例(1.8%,14/796),在活产儿中先天梅毒感染率为0.03‰(14/460552)。(4)孕期治疗者宫内传播率明显低于未治疗者[0.4%(3/716)与13.8%(11/80),χ^(2)=66.498,P<0.001]。随着未治疗孕妇非特异性抗体滴度增加,宫内传播率增加(χ^(2)_(趋势)=5.338,P=0.021)。3例孕期治疗后发生宫内传播者母儿无明显不良结局,11例孕期未治疗者发生宫内传播者中4例足月分娩、7例早产,11例新生儿中2例死亡。结论自实施预防梅毒宫内传播的措施以来,南通市先天梅毒报告发病率为3/10万活产,达到了国家制订的<15/10万的防控目标。孕早期筛查和治疗是预防梅毒宫内传播的关键。提高产前梅毒筛查率,有助于今后进一步减少梅毒宫内传播。Objective To evaluate the intrauterine transmission of syphilis in Nantong City,Jiangsu Province from 2012 to 2019,after the introduction of a nationwide policy for preventing intrauterine transmission of syphilis in China in 2011.Methods This study enrolled all live birth deliveries(n=455561)in Nantong from January 2012 to December 2019.The screening,infection rates,anti-syphilis treatment,intrauterine transmission of syphilis,and outcomes of infants with congenital syphilis were retrospectively analyzed usingχ^(2)test for trend,adjustedχ^(2)test,or Fisher's exact test.Results Except for three women,the remaining 455558 subjects were all screened for syphilis antibody with a total screening rate of nearly 100%,among which prenatal screening accounted for 96.4%(439125/455561)and intrapartum screening for 3.6%(16433/455561).In total,796(0.17%)women were diagnosed with syphilis during pregnancy,and the prevalence increased from 0.13%(85/64229)in 2012 to 0.24%(110/45517)in 2019(χ^(2)_(trend)=48.985,P<0.001).The prevalence among women underwent intrapartum screening was significantly higher than those underwent prenatal screening[0.50%(82/16433)vs 0.16%(714/439125),χ^(2)=102.769,P<0.001].Out of the women with syphilis,716(89.9%)received anti-syphilis therapy with 695 cases using penicillin,16 cases using ceftriaxone and five using erythromycin/azithromycin,while the remaining 80(10.1%)did not.Intrauterine transmission of syphilis occurred in 14 infants with a transmission rate of 1.8%(14/796).The reported rate of congenital syphilis in all live infants was 0.03‰(14/460552).The intrauterine transmission rate in women receiving treatment during pregnancy was significantly lower than that in the untreated women[0.4%(3/716)vs 13.8%(11/80),χ^(2)=66.499,P<0.001].For the untreated women,the intrauterine transmission rate increased with the rising titers of non-specific syphilis antibody(χ^(2)_(trend)=5.338,P=0.021).Among infants with congenital syphilis,no obvious adverse outcomes occurred in three infants born to t

关 键 词：梅毒 先天性 妊娠并发症 感染性 传染性疾病传播 垂直 普查 

分 类 号：R759.15[医药卫生—皮肤病学与性病学]