2015－2020年广东省梅毒感染孕产妇不良妊娠结局状况及影响因素分析

朱元浩; 高峰; 张书豪; 饶金; 高爽

doi:10.3784/jbjc.202207050312

2015－2020年广东省梅毒感染孕产妇不良妊娠结局状况及影响因素分析

doi: 10.3784/jbjc.202207050312

朱元浩^1,,
高峰²,
张书豪²,
饶金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工作，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
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出版历程
- 收稿日期: 2022-07-05
- 网络出版日期: 2022-11-08
- 刊出日期: 2022-12-01

Adverse pregnancy outcomes and influencing factors in pregnant women suffered from syphilis in Guangdong, 2015−2020

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感染特征和不良妊娠结局的影响因素，为制定降低不良妊娠结局发生的政策提供依据。方法从“全国预防艾滋病、梅毒和乙肝母婴传播信息管理系统”中收集2015—2020年广东省梅毒感染孕产妇及所生新生儿的相关信息，对梅毒感染孕产妇不良妊娠结局的相关危险因素进行χ²检验和多因素logistic回归分析。结果不同年龄段、文化程度、婚姻状态、既往诊断情况、本次诊断时期、本次诊断梅毒分期、治疗情况、初次治疗时期发生不良妊娠的差异有统计学意义（P<0.05）；多因素logistic回归分析显示，年龄≤20岁、文化程度小学及以下者发生不良妊娠的风险较大；既往未诊断梅毒者发生不良妊娠的风险较大（OR=1.350，95%CI：1.202～1.517）；产时、产后诊断感染者较孕期诊断者发生不良妊娠的风险大；不在婚者较在婚者发生不良妊娠的风险大（OR=1.280，95%CI：1.027～1.420）；本次诊断为Ⅱ、 Ⅲ期梅毒者较隐性梅毒者发生不良妊娠的风险大（OR=1.882，95%CI：1.039～3.195）；未进行治疗者不良妊娠发生的风险较大（OR=3.465，95%CI：2.508～4.786）；孕晚期再治疗者较孕早期治疗者发生不良妊娠的风险大（OR=2.245，95%CI=1.850～2.724）。结论年龄、文化程度、婚姻状况、诊断与治疗时期是梅毒感染孕产妇发生不良妊娠结局的影响因素。早期筛查、诊断并及时进行规范治疗对阻断梅毒母婴传播及预防不良妊娠结局具有重要意义。
- 妊娠合并梅毒 /
- 不良妊娠结局 /
- 影响因素
Abstract: Objective To analyze the infection characteristics and the influencing factors of adverse pregnancy outcomes in pregnant women suffered from syphilis in Guangdong province, and provide evidence for the development of prevention and control measures to reduce the incidence of adverse pregnancy outcomes. Methods The information of pregnant women suffered from syphilis and newborns in Guangdong from 2015 to 2020 were collected from “National Information Management System for the Prevention of Mother to Child Transmission of AIDS, Syphilis and Hepatitis B”, and χ² test and multivariate logistic regression analysis were conducted to identify risk factors of adverse pregnancy outcomes of these pregnant women. Results The results of χ² test showed that there were significant differences in the incidence of adverse pregnancy among the pregnant women with different age, education levels, marital status, previous diagnoses, current diagnosis times, stages of syphilis in current diagnosis, treatment status and initial treatment times (P<0.05). Multivariate Logistic regression analysis showed that the risk of adverse pregnancy was higher in those aged 20 years and below and those with primary education level. Those who were not diagnosed with syphilis previously had higher risk for adverse pregnancy (OR=1.350, 95% CI: 1.202−1.517). The risk for adverse pregnancy was higher in the pregnant women diagnosed with syphilis at and after delivery than in those diagnosed during pregnancy. The unmarried women had higher risk for adverse pregnancy than the married women (OR=1.280, 95% CI: 1.027−1.420). The risk of adverse pregnancy was higher in the pregnant women with phase Ⅱ or Ⅲ syphilis than in those with recessive syphilis (OR=1.882, 95% CI: 1.039−3.195). The risk of adverse pregnancy was higher in the pregnant women without treatment (OR=3.465, 95% CI: 2.508−4.786). The risk of adverse pregnancy was higher in the pregnant women receiving treatment later in pregnancy than in patients receiving treatment early in pregnancy (OR=2.245, 95% CI: 1.850−2.724). Conclusion Age, education level, marital status, diagnosis and treatment time are the influencing factors of adverse pregnancy outcomes in pregnant women suffered from syphilis. Early screening, diagnosis and timely standardized treatment are of great importance in blocking mother to child transmission of syphilis and preventing adverse pregnancy outcomes.
- Pregnancy complicated with syphilis /
- Adverse pregnancy outcome /
- Influence factor

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表 1 不同年份梅毒感染孕产妇治疗情况及不良妊娠结局情况比较

Table 1. Comparison of treatment and adverse pregnancy outcomes of pregnant women suffered from syphilis in different years

年份	报告病例数（例）	实施治疗		发生不良妊娠结局
年份	报告病例数（例）	例数（例）	治疗率（%）	例数（例）	发病率（%）
2015	1 767	1 432	81.04	179	10.13
2016	3 453	2 904	84.10	303	8.77
2017	3 204	2 817	87.92	227	7.08
2018	3 330	2 979	89.46	235	7.06
2019	3 563	3 235	90.79	256	7.18
2020	3 595	3 411	94.88	214	5.95
合计	18 912	16 778	88.72	1 414	7.48

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表 2 不同特征梅毒感染孕产妇发生不良妊娠结局情况的比较

Table 2. Comparison of adverse pregnancy outcomes among pregnant women suffered from syphilis with different characteristics

特征	调查数（例）	构成比（%）	不良妊娠结局
特征	调查数（例）	构成比（%）	病例数（例）	发生率（%）	χ²值	P值
年龄组（岁）					54.162	<0.01
0～	1 221	6.46	152	12.45
21～	4 225	22.34	333	7.88
26～	5 126	27.10	350	6.83
31～	4 646	24.57	302	6.50
36～	3 694	19.53	277	7.50
民族					0.004	0.950
汉族	17 607	93.10	1317	7.48
其他	1 305	6.90	97	7.43
文化程度					46.445	<0.01
小学及以下	2 072	10.96	222	10.71
初/高中	14 083	74.46	1 013	7.19
大学及以上	1 647	8.71	86	5.22
不详	1 110	5.87	93	8.38
职业					3.027	0.220
农/渔/牧民	2 370	12.53	179	7.55
家务及待业	10 661	56.37	824	7.73
其他	5 881	31.10	411	6.99
婚姻状况					29.921	<0.01
在婚	16 446	86.96	1 163	7.07
不在婚	2 466	13.04	251	10.18
产次					0.739	0.390
初产妇	5 999	31.72	463	7.72
经产妇	12 913	68.28	951	7.37
既往诊断梅毒					67.517	<0.01
是	8 953	47.34	521	5.82
否	9 959	52.66	893	8.97
本次诊断梅毒时期					91.656	<0.01
孕期	15 019	79.42	984	6.56
产时	2 663	14.08	293	11.00
产后	1 163	6.15	132	11.35
不详	67	0.35	5	7.46
本次诊断梅毒分期					34.084	<0.01
隐性	16 586	87.70	1 173	7.07
Ⅰ期	577	3.05	54	9.22
Ⅱ/Ⅲ期	114	0.60	15	13.16
不详	1635	8.65	172	10.58
感染途径					2.631	0.621
性传播	7 159	37.86	545	7.61
血液传播	116	0.61	12	10.35
母婴传播	100	0.53	6	6.00
其他	72	0.38	7	9.72
不详	11 465	60.62	844	7.36
接受治疗					49.414	<0.01
是	16 778	88.72	1 174	7.00
否	2 134	11.28	240	11.25
首次治疗时期					230.641	<0.01
孕早期	3 496	18.48	171	4.89
孕中期	8 330	44.05	481	5.77
孕晚期	3 629	19.19	470	12.95
孕前期	64	0.34	5	7.81
其他	3 393	17.94	287	8.46

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表 3 梅毒感染孕产妇发生不良妊娠结局影响因素分析

Table 3. Influencing factors of adverse pregnancy outcome in pregnant women suffered from syphilis

影响因素	β	$s_{\bar x}$	Wald χ²值	P值	OR值（95%CI）
年龄组（岁）
0～					1.000
21～	−0.258	0.112	5.286	0.021	0.772（0.620～0.963）
26～	−0.359	0.114	9.881	0.002	0.698（0.558～0.874）
31～	−0.443	0.117	14.322	<0.01	0.642（0.510～0.808）
36～	−0.364	0.118	9.444	0.002	0.695（0.551～0.877）
文化程度
小学及以下					1.000
初/高中	−0.278	0.081	11.877	0.001	0.757（0.647～0.887）
大学及以上	−0.419	0.135	9.577	0.002	0.658（0.504～0.858）
婚姻
在婚					1.000
不在婚	0.189	0.083	5.227	0.022	1.280（1.027～1.420）
既往诊断
是					1.000
否	0.300	0.060	25.459	<0.01	1.350（1.202～1.517）
本次诊断时期
孕期					1.000
产时	0.306	0.084	13.424	<0.01	1.358（1.153～1.600）
产后	0.289	0.112	6.681	0.001	1.335（1.072～1.663）
本次诊断梅毒分期
隐性					1.000
Ⅱ/Ⅲ期	0.600	0.287	4.380	0.036	1.822（1.039～3.195）
不详	0.279	0.089	9.883	0.002	1.322（1.111～1.572）
接受治疗
是					1.000
否	1.243	0.165	56.847	<0.01	3.465（2.508～4.786）
首次治疗时期
孕早期					1.000
孕晚期	0.809	0.099	67.063	<0.01	2.245（1.850～2.724）

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