弓形虫感染与妊娠结局的关系  

Prospective study on the relationship between treatment of toxoplasmosis and pregnancy outcome

作　　者：闻良珍[1] 刘兰青[2] 敖黎明[3] 陈素华[1] 曾万江[1] 姜宏[1] 凌霞珍[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院妇产科,武汉430030 [2]中国医科大学 [3]上海第二医科大学

出　　处：《中华围产医学杂志》2004年第2期83-85,共3页Chinese Journal of Perinatal Medicine

基　　金：国家"九五"科技攻关计划 (96 90 4 0 6 0 8)

摘　　要：目的　探讨弓形虫 (toxoplasma ,Tox)感染治疗与妊娠结局的关系。 方法　采用ELISA结合PCR法检出Tox感染并要求治疗的孕妇 5 9例及育龄妇女 91例 (治疗组 ) ,均给予口服乙酰螺旋霉素治疗 ,与同期检出Tox感染 ,但未行治疗的孕妇 6 0例和育龄妇女 79例 (对照组 )进行比较 ,比较其Tox IgM及DNA转阴率、宫内垂直传播率及异常妊娠结局发生率。 　结果　治疗组孕妇及育龄妇女外周血中Tox转阴率分别为 83 0 5 % (49/ 5 9)和 70 33% (6 4 / 91) ,对照组孕妇Tox自然转阴率为35 % (2 1/ 6 0 ) ,育龄妇女为 37 97% (30 / 79) ;宫内垂直传播率为 8 4 % (5 / 5 9) ,明显低于对照组的 4 0 %(2 0 / 5 0 ) (χ2 =11 4 970 ,P <0 .0 0 1) ,相对危险度为 0 2 97;随访育龄妇女经治疗Tox转阴后怀孕 2 9例 ,足月分娩 17例 ,脐血Tox IgM、DNA均为阴性 ,体检未发现新生儿异常。　 结论　孕前检测和治疗Tox感染能有效控制胎儿受染 ;孕期治疗能减少孕妇感染 ,降低宫内垂直传播率 ,减少胎儿受损 ,改善妊娠结局。Objective To explore prospectively the relationship between treatment of toxoplasmosis and pregnancy outcome. Methods Detected by ELISA and PCR,59 pregnant women and 91 women at reproductive age with infection were treated by oral spiramycin. Then their Tox-lgM and DNA negative conversing rates,intrauterine transmission rate and incidence of abnormal pregnancy outcome were studied in contrast to those of 60 women in pregnancy and 79 at childbearing age with infection but without management. Results In healing group,the seroconversion rate of Tox-lgM and Tox-DNA from positive to negative were 83.05% (49/59) in pregnant women and 70.33%(64/91) in women at childbearing age,respectively. The rates in control group were 35% (21/60) and 37.97% (30/79). The rates of intrauterine transmission and abnormal pregnancy outcomes of healing group were 8.4% (5/59) and 30% (15/50),respectively. While those of control group were 11.86% (7/59) and 40% (20/50) accordingly (χ 2=11.4970,P<0.001,RR=0.297). There was significant difference between the healing group and control group. In addition,29 women in healing group were investigated who fell pregnant after seroconversion from positive to negative. Among them,17 cases had term deliveries with both negative Tox-lgM and Tox-DNA in umbilical blood and no neonatal abnormality was detected. Conclusion Preconceptional test and therapy of toxoplasmosis can effectively prevent fetal injury,while therapy for infection in pregnancy improves pregnancy outcomes and prevents fetus from infection with the result of decreased intrauterine transmission rate.

关 键 词：弓形虫感染 妊娠结局 ELISA 治疗 乙酰螺旋霉素 

分 类 号：R714.25[医药卫生—妇产科学]