广东省妊娠合并梅毒母婴传播影响因素分析

朱元浩; 邵健锋; 高峰; 张书豪; 高爽

doi:10.3784/jbjc.202206220288

广东省妊娠合并梅毒母婴传播影响因素分析

doi: 10.3784/jbjc.202206220288

朱元浩^1,,
邵健锋²,
高峰²,
张书豪²,
高爽^2, ,

1.
暨南大学基础医学与公共卫生学院, 广东广州 510632
2.
广东省妇幼保健院, 广东广州 511442

详细信息

作者简介:
朱元浩，男，江西省上饶市人，硕士，主要从事传染病防治，Email：2770165925@qq.com

通讯作者:
高爽，Tel：020−39151937，Email：gaoshuang020@126.com

中图分类号: R211; R759.1
计量
- 文章访问数: 192
- HTML全文浏览量: 80
- PDF下载量: 8
- 被引次数: 0
出版历程
- 收稿日期: 2022-06-22
- 网络出版日期: 2022-11-28
- 刊出日期: 2022-12-01

Influencing factors for mother to child transmission of syphilis in pregnancy in Guangdong

1.
School of Basic Medicine and Public Health, Jinan University, Guangzhou 510632, Guangdong, China
2.
Guangdong Maternal and Child Health Center, Guangzhou 511442, Guangdong, China

More Information

Corresponding author: Gao Shuang, Email: gaoshuang020@126.com

摘要

摘要: 目的分析广东省梅毒感染孕产妇的特征及其母婴传播影响因素，为广东省消除母婴传播政策制定提供依据。方法以2014年1月1日至2021年2月1日广东省发生胎传梅毒的感染孕产妇为病例组，另以同地区、同分娩年度为匹配条件，筛选出未发生胎传梅毒的梅毒感染孕妇为对照组。对相关危险因素进行单因素和多因素条件logistic回归分析。结果多因素条件logistic回归分析显示，同≤20岁年龄组的孕产妇相比，21～25岁（OR=0.537，95%CI：0.341～0.845）、26～30岁（OR=0.43，95%CI：0.272～0.679）、31～35岁（OR=0.322，95%CI：0.202～0.512）和≥36岁者（OR=0.321，95%CI：0.194～0.532）发生母婴传播的风险均较低；既往未发现患梅毒的孕产妇发生母婴传播的风险较高（OR=1.837，95%CI：1.352～2.495）；同在孕期就已经诊断患病的孕产妇相比，产时和产后诊断患梅毒的孕产妇发生梅毒母婴传播的风险均较高（OR=2.026，95%CI：1.472～2.790）、（OR=1.951，95%CI：1.333～2.856）；同孕早期进行治疗的孕产妇相比，孕中期和孕晚期进行治疗孕产妇发生母婴传播的风险较高（OR=3.712，95%CI：1.977～6.970）、（OR=11.531，95%CI：6.363～20.894）。结论在消除梅毒母婴传播的工作中需加强对低龄孕产妇梅毒等性病防治的健康教育，提高梅毒防病知识。妊娠合并梅毒早发现、早诊断、早治疗是降低梅毒母婴传播的关键，通过早期梅毒筛查、诊断和治疗能够有效的降低梅毒母婴传播发生的风险。
- 妊娠合并梅毒 /
- 母婴传播 /
- 先天梅毒
Abstract: Objective To analyze the characteristics of pregnant women infected with syphilis and the influencing factors of mother to child transmission in Guangdong province, and provide evidence for the development of policies form the elimination of the mother to child transmission. Methods Infected pregnant women who developed fetal transmitted syphilis from January 1, 2014 to February 1, 2021 in Guangdong Province were selected as the case group, and another pregnant women with syphilis infection who did not develop fetal transmitted syphilis were screened as the control group using the same region and year of delivery as matching conditions. Results Multivariate conditional logistic regression analysis showed that compared with pregnant women aged ≤20 years, the risk for mother to child transmission of syphilis was lower in those aged 21−25 years (OR=0.537, 95% CI: 0.341−0.845), 26−30 years (OR=0.43, 95% CI: 0.272−0.679), 31−35 years (OR=0.322, 95% CI: 0.202−0.512) and ≥36 years (OR=0.321, 95% CI: 0.194−0.532); The risk for the mother to child transmission in pregnant women with non-diagnosed syphilis was higher (OR=1.837, 95% CI: 1.352−2.495); Compared with the pregnant women who were diagnosed with syphilis during pregnancy, the pregnant women who were diagnosed with syphilis during labor and after delivery had higher risk of mother to child transmission of syphilis (OR=2.026, 95% CI: 1.472−2.790), (OR=1.951, 95% CI: 1.333−2.856). Compared with the pregnant women receiving treatment in the first trimester, the pregnant women receiving treatment in the second and third trimesters had higher risk of mother to child transmission of syphilis (OR=3.712, 95% CI: 1.977−6.970), (OR=11.531, 95% CI: 6.363−20.894). Conclusion In the elimination of mother to child transmission of syphilis, it is necessary to strengthen the health education about the prevention and treatment of sexually transmitted diseases, such as syphilis, in young pregnant women, and improve their awareness of syphilis prevention. Early detection, diagnosis and treatment of syphilis in pregnancy are essential to reduce mother to child transmission of syphilis. Early screening, diagnosis and treatment of syphilis can effectively reduce the risk of mother to child transmission of syphilis
- Pregnancy complicated with syphilis /
- Mother-to-child transmission /
- Congenital syphilis

HTML全文

表 1 梅毒感染孕产妇母婴传播影响因素的单因素分析

Table 1. Univariate analysis on influencing factors for mother to child transmission of syphilis in pregnant women

类别	特征	病例组（例）	对照组（例）	χ²值	P值
人口学特征	年龄组（岁）			54.591	<0.01
	0～	59	79
	21～	109	367
	26～	104	429
	31～	73	422
	36～	51	287
	民族			0.000	1.000
	汉族	370	1 480
	其他	26	104
	婚姻状态			26.155	<0.01
	在婚	313	1 408
	不在婚	83	176
	教育程度			1.705	0.426
	小学及以下	75	317
	初中/高中	302	1 163
	大学及以上	19	104
	职业			3.889	0.143
	农民/牧民/渔民	74	334
	家务及待业	245	892
	其他	77	358
孕产史	产次			0.072	0.789
	初产妇	115	468
	经产妇	281	1 116
梅毒感染孕产妇诊断与治疗情况	既往诊断感染			42.527	<0.01
	是	79	594
	否	317	990
	梅毒感染途径			0.237	0.888
	性传播	158	640
	其他途径	5	24
	不详	233	920
	本次诊断梅毒时期			51.764	<0.001
	孕期	197	1 093
	产时	130	314
	产后	69	177
	本次诊断梅毒分期			31.444	<0.01
	隐性	269	1 267
	Ⅰ期	23	67
	Ⅱ/Ⅲ期	2	17
	不详	102	233
	孕产妇药物治疗的时期			112.482	<0.001
	孕早期	13	358
	孕中期	62	413
	孕晚期	167	323
	孕前	2	12
	其他	152	478
	治疗药物			112.482	<0.001
	青霉素治疗	275	1 203
	其他药物治疗	16	46
	不用药	105	335
梅毒感染孕产妇分娩情况	分娩方式			2.751	0.253
	阴道产	243	918
	剖宫产	130	540
	不详	23	126
	出现孕产期异常情况			4.577	0.714
	是	64	192
	否	332	1 392
	发生胎膜早破			0.010	0.919
	是	21	62
	否	375	1 502
	发生产后出血
	是	4	14	0.057	0.811
	否	392	1 570
新生儿基本特征及治疗情况	新生儿性别			0.437	0.509
	男性	209	863
	女性	187	721
	新生儿身长（cm）			109.213	<0.01
	≤45	87	64
	>45	309	1 520
	新生儿体重（g）			125.739	<0.01
	≤2500	129	138
	>2500	267	1 446
	新生儿接受预防性治疗			0.173	0.677
	是	260	1 057
	否	136	527

下载: 导出CSV

表 2 梅毒母婴传播多因素logistic回归分析

Table 2. Multivariate Logistic regression analysis on influencing factors for mother to child transmission of syphilis

影响因素	β	$s_{\bar x}$	χ²值	P值	OR值（95%CI）
年龄组（岁）
0～					1.000
21～	−0.623	0.231	7.236	<0.01	0.537（0.341～0.845）
26～	−0.845	0.233	13.132	<0.01	0.430（0.272～0.679）
31～	−1.134	0.237	22.881	<0.01	0.322（0.202～0.512）
36～	−1.135	0.257	19.486	<0.01	0.321（0.194～0.532）
既往诊断感染
是					1.000
否	0.608	0.156	15.129	<0.01	1.837（1.352～2.495）
本次诊断时期
孕期					1.000
产时	0.706	0.163	18.726	<0.01	2.026（1.472～2.790）
产后	0.668	0.194	11.819	<0.01	1.951（1.333～2.856）
孕产妇药物治疗时期
孕早期					1.000
孕中期	1.311	0.321	16.643	<0.01	3.712（1.977～6.970）
孕晚期	2.445	0.303	64.986	<0.01	11.531（6.363～20.894）
其他	1.575	0.314	25.177	<0.01	4.829（2.610～8.932）

下载: 导出CSV

参考文献(22)

[1]	高洁, 邹颖, 吴颖岚, 等. 2013-2016年湖南省预防梅毒母婴传播工作效果分析[J]. 中国艾滋病性病,2018,24(6):619–621. DOI: 10.13419/j.cnki.aids.2018.06.23. Gao J, Zou Y, Wu YL, et al. Effect of prevention of mother to child transmission of syphilis in Hunan from 2013 to 2016[J]. Chin J AIDS STDS, 2018, 24(6): 619–621. DOI: 10.13419/j.cnki.aids.2018.06.23.
[2]	秦家碧, 杨土保, 谭红专, 等. 孕产妇梅毒患者不良妊娠结局发生率的系统综述和Meta分析[J]. 中华皮肤科杂志,2015,48(7):512–515. DOI:10.3760/cma.j.issn.0412−4030.2015.07.023. Qin JB, Yang TB, Tan HZ, et al. A systematic review and meta-analysis of the incidence of adverse pregnancy outcomes in maternal syphilis patients[J]. Chin J Dermatol, 2015, 48(7): 512–515. DOI: 10.3760/cma.j.issn.0412−4030.2015.07.023.
[3]	Dou LX, Wang XY, Wang F, et al. Epidemic profile of maternal syphilis in China in 2013[J]. BioMed Res Int, 2016, 2016: 9194805. DOI: 10.1155/2016/9194805.
[4]	付翰林, 刘晓英, 秦家碧, 等. 我国妊娠梅毒中先天梅毒报告发病率的Meta分析[J]. 中华传染病杂志,2015,33(6):363–368. DOI:10.3760/cma.j.issn.1000−6680.2015.06.013. Fu HL, Liu XY, Qin JB, et al. A meta-analysis of the reported incidence of congenital syphilis in pregnant syphilis in China[J]. Chin J Infect Dis, 2015, 33(6): 363–368. DOI: 10.3760/cma.j.issn.1000−6680.2015.06.013.
[5]	Slutsker JS, Hennessy RR, Schillinger JA. Factors contributing to congenital syphilis cases - New York city, 2010–2016[J]. MMWR Morb Mortal Wkly Rep, 2018, 67(39): 1088–1093. DOI: 10.15585/mmwr.mm6739a3.
[6]	Korenromp EL, Rowley J, Alonso M, et al. Correction: Global burden of maternal and congenital syphilis and associated adverse birth outcomes-Estimates for 2016 and progress since 2012[J]. PLoS One, 2019, 14(7): e0219613. DOI: 10.1371/journal.pone.0219613.
[7]	Wu YL, Gao J, Qin JB, et al. Mother-to-child transmission prevention of human immunodeficiency virus, syphilis and hepatitis B virus[J]. Women Birth, 2019, 32(6): 570–578. DOI: 10.1016/j.wombi.2018.11.004.
[8]	高爽, 朱颖贤, 梁海英, 等. 2016-2020年广东省消除艾滋病、梅毒和乙肝母婴传播效果分析[J]. 中国健康教育,2021,37(10):872–875,893. DOI:10.16168/j.cnki.issn.1002−9982.2021.10.002. Gao S, Zhu YX, Liang HY, et al. Effect of elimination on HIV, syphilis and hepatitis B transmission by mother to child in Guangdong province, 2016−2020[J]. Chin J Health Educ, 2021, 37(10): 872–875,893. DOI: 10.16168/j.cnki.issn.1002−9982.2021.10.002.
[9]	金慧莉, 丁莉莉. 普外科梅毒初筛阳性患者对梅毒相关知识的知晓状况及影响因素分析[J]. 中国性科学,2021,30(11):148–151. DOI:10.3969/j.issn.1672−1993.2021.11.045. Jin HL, Ding LL. Awareness status of related disease knowledge and influencing factors in patients with positive initial screening for syphilis in department of general surgery[J]. Chin J Human Sexual, 2021, 30(11): 148–151. DOI: 10.3969/j.issn.1672−1993.2021.11.045.
[10]	徐增辉, 计国平, 洪涛, 等. 安徽省孕妇人群梅毒防治知识调查分析[J]. 中国艾滋病性病,2018,24(3):279–282. DOI: 10.13419/j.cnki.aids.2018.03.18. Xu ZH, Ji GP, Hong T, et al. Awareness of syphilis prevention and treatment among pregnant women in Anhui province[J]. Chin J AIDS STD, 2018, 24(3): 279–282. DOI: 10.13419/j.cnki.aids.2018.03.18.
[11]	薛艳萍, 窦丽霞, 王爱玲, 等. 2015年华东地区梅毒感染孕产妇人群特征分析[J]. 中国妇幼卫生杂志,2018,9(3):1–4. DOI:10.19757/j.cnki.issn1674−7763.2018.03.001. Xue YP, Dou LX, Wang AL, et al. Characteristics of syphilis-infected pregnant women in East China in 2015[J]. Chin J Women Child Health, 2018, 9(3): 1–4. DOI: 10.19757/j.cnki.issn1674−7763.2018.03.001.
[12]	窦丽霞, 王爱玲, 王潇滟, 等. 妊娠合并梅毒孕妇的治疗及其不良妊娠结局的影响因素分析[J]. 中华妇产科杂志,2016,51(7):538–541. DOI:10.3760/cma.j.issn.0529−567x.2016.07.011. Dou LX, Wang AL, Wang XY, et al. Treatment of pregnant women with syphilis and its influencing factors of adverse pregnancy outcomes[J]. Chin J Obstetr Gynecol, 2016, 51(7): 538–541. DOI: 10.3760/cma.j.issn.0529−567x.2016.07.011.
[13]	窦丽霞, 王前, 王潇滟, 等. 中国华东地区感染梅毒孕产妇血清学指标监测分析[J]. 中华预防医学杂志,2018,52(1):68–72. DOI:10.3760/cma.j.issn.0253−9624.2018.01.013. Dou LX, Wang Q, Wang XY, et al. Serologic surveillance indicators analysis among syphilis-infected pregnant women in East China[J]. Chin J Prev Med, 2018, 52(1): 68–72. DOI: 10.3760/cma.j.issn.0253−9624.2018.01.013.
[14]	World Health Organization. Global guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV, syphilis and hepatitis B virus[EB/OL]. (2021-08-04)[2022-07-23]. https://www.who.int/publications/i/item/9789240039360.
[15]	Wang YJ, Wu MZ, Gong XD, et al. Risk factors for congenital syphilis transmitted from mother to infant - Suzhou, China, 2011–2014[J]. MMWR Morb Mortal Wkly Rep, 2019, 68(10): 247–250. DOI: 10.15585/mmwr.mm6810a4.
[16]	Zhang X, Yu Y, Yang HJ, et al. Surveillance of maternal syphilis in China: pregnancy outcomes and determinants of congenital syphilis[J]. Med Sci Monit, 2018, 24: 7727–7735. DOI: 10.12659/MSM.910216.
[17]	Wan ZH, Zhang H, Xu HG, et al. Maternal syphilis treatment and pregnancy outcomes: a retrospective study in Jiangxi province, China[J]. BMC Pregnancy Childbirth, 2020, 20(1): 648. DOI: 10.1186/s12884−020−03314−y.
[18]	Hong FC, Wu XB, Yang F, et al. Risk of Congenital Syphilis (CS) following treatment of maternal syphilis: results of a CS control program in China[J]. Clin Infect Dis, 2017, 65(4): 588–594. DOI: 10.1093/cid/cix371.
[19]	De Oliveira SIM, De Oliveira Saraiva COP, De França DF, et al. Syphilis notifications and the triggering processes for vertical transmission: a cross-sectional study[J]. Int J Environ Res Public Health, 2020, 17(3): 984. DOI: 10.3390/ijerph17030984.
[20]	李东纯, 郑敏纯. 不同治疗时机对梅毒妊娠孕妇母婴结局的影响[J]. 中国当代医药,2019,26(33):159–161. DOI:10.3969/j.issn.1674−4721.2019.33.049. Li DC, Zheng MC. Effect of different treatment timing on maternal and fetal outcomes in patients with syphilis pregnancy[J]. China Mod Med, 2019, 26(33): 159–161. DOI: 10.3969/j.issn.1674−4721.2019.33.049.
[21]	徐约丹, 沈旭娜, 张常乐, 等. 妊娠梅毒的孕期干预时机对妊娠结局的影响分析[J]. 中国艾滋病性病,2015,21(5):418–420,424. DOI: 10.13419/j.cnki.aids.2015.05.18. Xu YD, Shen XN, Zhang CL, et al. Effect of intervention time on pregnancy outcomes among pregnant women with syphilis[J]. Chin J AIDS STD, 2015, 21(5): 418–420,424. DOI: 10.13419/j.cnki.aids.2015.05.18.
[22]	姚爱媛, 朱东波, 吕颖. 妊娠合并梅毒致母婴传播的高风险因素分析[J]. 中国艾滋病性病,2020,26(12):1352–1354,1364. DOI: 10.13419/j.cnki.aids.2020.12.22. Yao AY, Zhu DB, Lyu Y. High risk factors of mother-to-child transmission in pregnancy with syphilis[J]. Chin JAIDS STD, 2020, 26(12): 1352–1354,1364. DOI: 10.13419/j.cnki.aids.2020.12.22.