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目的探讨妊娠合并梅毒患者的母婴传播规律与干预方法。方法对确诊的847例妊娠合并梅毒孕妇进行孕期干预,孕早期3个月内(或)一经确诊梅毒、及孕晚期3个月时各行抗梅毒治疗1个疗程共计2个疗程。以普鲁卡因青霉素80万 U/d,肌内注射,连续10～15 d;路远不便者用苄星青霉素240万 U,分两侧臀部注射,1次/周,连续3次为1个疗程。对青霉素过敏者改用红霉素治疗,每次0.5 g 口服,4次/d,连续15 d 为1个疗程。随访并观察其妊娠结局。新生儿进行快速血浆反应素环状卡片试验(RPR)及梅毒密螺旋体血凝试验(TPHA)确诊检查,对其中 RPR 及 TPHA 阳性的新生儿进行干预,以普鲁卡因青霉素5万 U·kg~(-1)·d~(-1),肌内注射,连续10～15 d。并于出生后3、6、9、12、24个月复查静脉血 RPR。结果 (1)847例妊娠合并梅毒孕妇中,已分娩772例,活产新生儿733例,行 RPR 检查626例,新生儿 RPR 阳性率为55.1%(345/626)。(2)RPR 滴度≥1:8的孕妇分娩的新生儿 RPR 阳性率、围产儿死亡率、早产率、低出生体重儿发生率均高于 RPR 滴度<1:8的孕妇(P<0.01)。(3)新生儿 RPR 阳性率与孕妇治疗时机:①孕前抗梅毒治疗孕妇与孕前未抗梅毒治疗孕妇的新生儿 RPR 阳性率分别为22.4%(15/67)和49.6%(330/666,P<0.01);②孕前抗梅毒治疗孕妇与孕期抗梅毒治疗孕妇的新生儿 RPR 阳性率分别为22.4%(15/67)和40.3%(240/595,P<0.05);③孕早、晚期各抗梅毒治疗1个疗程与仅孕晚期抗梅毒治疗1个疗程比较,新生儿 RPR 阳性率分别为28.5%(45/158)和56.9%(95/167,P<0.01)。孕中、晚期各抗梅毒治疗1个疗程者与仅孕晚期抗梅毒治疗1个疗程者比较,新生儿 RPR 阳性率分别为37.0%(100/270)和56.9%(95/167,P<0.05)。(4)RPR 阳性新生儿随访至出生后24个月时全部转为阴性。结论妊娠合并梅毒孕妇的母婴传播率、围产儿预后与孕妇 RPR 滴度、治疗时机有关;孕前抗梅毒治疗孕妇的新生儿 RPR 阳性率明显低于孕前未抗梅毒治疗者;治疗后妊娠是阻断母婴传播的有力措施。
Objective To explore the maternal-to-infant transmission and intervention methods in pregnant women with syphilis. Methods A total of 847 pregnancies with syphilis during pregnancy were intervened during the first trimester of pregnancy. Syphilis was confirmed within 3 months of pregnancy in the first trimester, and three courses of anti-syphilis were administered in two courses during the third trimester of pregnancy. To procaine penicillin 800000 U / d, intramuscular injection, continuous 10 ~ 15 d; Lu Yuan inconvenience with benzathine penicillin 2.4 million U, on both sides of the buttocks injection, 1 / week, 3 times in a row as 1 A course of treatment. Penicillin allergy to erythromycin to treatment, each 0.5 g orally, 4 times / d, for 15 days for a course of treatment. Follow-up and observe the pregnancy outcome. Neonates were diagnosed by RPR and TPHA, and RPR and TPHA-positive neonates were intervened. The newborn infants were treated with procaine penicillin 50,000 U · kg ~ (-1) · d ~ (-1), intramuscular injection, continuous 10 ~ 15 d. Venous blood RPR was reviewed at 3, 6, 9, 12 and 24 months after birth. Results (1) Of 847 pregnancy pregnant women with syphilis, 772 have been delivered and 733 live births were performed. There were 626 cases of RPR examination, and the positive rate of RPR in newborns was 55.1% (345/626). (2) The RPR positive rate, perinatal mortality rate, preterm birth rate and low birth weight infants born to pregnant women with RPR titer≥1: 8 were higher than those with RPR titer <1: 8 (P <0.01) ). (3) The positive rate of RPR in neonates and the timing of treatment for pregnant women: ① The positive rates of RPR in neonates with anti-syphilis before pregnancy and before anti-syphilis treatment were 22.4% (15/67) and 49.6% (330/666, P <0.01). ② The positive rates of RPR in neonates with anti-syphilis before pregnancy and anti-syphilis during pregnancy were 22.4% (15/67) and 40.3% (240/595, P <0.05) respectively. The rate of positive RPR in newborns was 28.5% (45/158) and 56.9% (95/167, P <0.01), respectively, for 1 course of anti-syphilis treatment and 1 course of anti-syphilis treatment only in the third trimester of pregnancy. The positive rate of RPR in newborns was 37.0% (100/270) and 56.9% (95/167, P <0.05), respectively, compared with those treated with only one course of anti-syphilis in the third trimester of pregnancy. ). (4) RPR positive neonates were followed up until 24 months after birth, all turned negative. Conclusion The maternal-infant transmission rate of pregnant women with syphilis and the prognosis of perinatal pregnancy are related to the timing of RPR and the timing of treatment. The positive rates of RPR in neonates with anti-syphilis before pregnancy are significantly lower than those without syphilis before pregnancy. Break the mother and child transmission of powerful measures.