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2015—2020年湖北省新生儿先天梅毒患病现状及其影响因素分析

徐阳欢,  张蕃,  代国红,  李德海,  马艳霞,  张瑛,  阎炯

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文章导航 > 中华疾病控制杂志  > 2022 >  26(9): 1030-1036
徐阳欢, 张蕃, 代国红, 李德海, 马艳霞, 张瑛, 阎炯. 2015—2020年湖北省新生儿先天梅毒患病现状及其影响因素分析[J]. 中华疾病控制杂志, 2022, 26(9): 1030-1036. doi: 10.16462/j.cnki.zhjbkz.2022.09.008
引用本文: 徐阳欢, 张蕃, 代国红, 李德海, 马艳霞, 张瑛, 阎炯. 2015—2020年湖北省新生儿先天梅毒患病现状及其影响因素分析[J]. 中华疾病控制杂志, 2022, 26(9): 1030-1036. doi: 10.16462/j.cnki.zhjbkz.2022.09.008
shu
XU Yang-huan, ZHANG Fan, DAI Guo-hong, LI De-hai, MA Yan-xia, ZHANG Ying, YAN Jiong. Morbidity and influencing factors of congenital syphilis in newborns in Hubei of China, 2015-2020[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2022, 26(9): 1030-1036. doi: 10.16462/j.cnki.zhjbkz.2022.09.008
Citation: XU Yang-huan, ZHANG Fan, DAI Guo-hong, LI De-hai, MA Yan-xia, ZHANG Ying, YAN Jiong. Morbidity and influencing factors of congenital syphilis in newborns in Hubei of China, 2015-2020[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2022, 26(9): 1030-1036. doi: 10.16462/j.cnki.zhjbkz.2022.09.008
shu

2015—2020年湖北省新生儿先天梅毒患病现状及其影响因素分析

doi: 10.16462/j.cnki.zhjbkz.2022.09.008
  • 1.

    430070 武汉市，湖北省妇幼保健院保健部

  • 2.

    430079 武汉市，湖北省疾病预防控制中心传染病防治研究所

基金项目: 

中国疾病预防控制中心妇幼保健中心"2020年度合生元母婴营养与健康研究项目" 2020FYH008

详细信息
    通讯作者:

    阎炯，E-mail: 514140326@qq.com

  • 中图分类号: R759.1+5

Morbidity and influencing factors of congenital syphilis in newborns in Hubei of China, 2015-2020

  • 1.

    Health Care Department, Maternal and Child Health Hospital of Hubei Province, Wuhan 430070, China

  • 2.

    Infectious Disease Prevention and Control Institute, Hubei Province Center for Disease Control and Prevention, Wuhan 430079, China

Funds: 

"2020 Biostime Maternal and Child Nutrition and Health Research Project" of National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention 2020FYH008

More Information

    摘要
  • 摘要:   目的  了解湖北省梅毒感染孕产妇的流行病学特征及所娩儿童先天梅毒的患病情况，探讨发生先天梅毒的相关影响因素。  方法  收集2015年1月1日—2020年12月31日湖北省预防艾滋病、梅毒和乙型肝炎(简称乙肝)母婴传播管理信息系统中报告的梅毒感染孕产妇的个案信息，对其人口学特征、梅毒的检测治疗情况和所娩儿童先天梅毒的患病情况进行分析。采用多因素logistic回归分析模型分析发生先天梅毒的影响因素。  结果  3 467例梅毒感染孕产妇的年龄为(29.79±5.43)岁，母婴传播率为3.17%(110例)，接受过驱梅治疗的比例为73.35%(2 543例)，规范治疗的比例为49.21%(1 706例)，接受预防性治疗的梅毒暴露儿童占74.82%(2 594例)。多因素分析结果显示，产时/产后确诊梅毒感染(OR=1.879, 95% CI：1.237~2.853)、丈夫/性伴感染梅毒(OR=3.762, 95% CI：1.473~9.608)、妊娠末次非梅毒螺旋体血清学试验(简称非梅试验)效价≥1∶8(OR=8.908, 95% CI：1.840~43.131)、未进行治疗(OR=6.360, 95% CI：3.316~12.199)、进行一般治疗(OR=4.714, 95% CI：2.385~9.320)、暴露儿童接受预防性治疗(OR=0.559, 95% CI：0.369~0.846)和足月产(OR=0.496, 95% CI：0.300~0.821)是影响先天梅毒发病的独立因素(均有P＜0.05)。  结论  梅毒感染孕产妇的确诊时期、妊娠末次非梅试验效价、治疗情况、分娩孕周、丈夫/性伴梅毒感染状况和暴露儿童预防性治疗情况与先天梅毒的发生密切相关。早期明确诊断并规范开展驱梅治疗和暴露儿童预防性治疗有助于降低先天梅毒的发生。
    Abstract:   Objective  To investigate the epidemiological characteristics of pregnant women with syphilis and the prevalence of congenital syphilis in their children in Hubei Province, and to explore the related influencing factors of congenital syphilis.  Methods  Data of syphilitic pregnant women was collected from the national integrated prevention of mother-to-child transmission of HIV, syphilis, and HBV information management system from January 1, 2015, and December 31, 2020. The demographic characteristics, detection and treatment of syphilis, and the prevalence of congenital syphilis were analyzed. A multiple logistic regression model was used to analyze the influencing factors of congenital syphilis.  Results  The average age of 3 467 syphilis-infected pregnant women was (29.79±5.43) years old, and the rate of mother-to-child transmission was 3.17% (110 cases). About 73.35% (2 543 cases) had received antisyphilitic treatment, 49.21% (1 706 cases) had received standard treatment, and 74.82% (2 594 cases) of children exposed to syphilis received preventive treatment. Multivariate analysis showed that the parturition or postpartum period of syphilis was diagnosed (OR=1.879, 95% CI: 1.237-2.853), the status of syphilis infection of husband/sexual partner (OR=3.762, 95% CI: 1.473-9.608), non-treatment (OR=6.360, 95% CI: 3.316-12.199), nonstandard treatment (OR=4.714, 95% CI: 2.385-9.320), the last non-treponema pallidum antigen serologic test result≥1∶8 (OR=8.908, 95% CI: 1.840-43.131), preventive treatment for exposed children (OR=0.559, 95% CI: 0.369-0.846) and term birth (OR=0.496, 95% CI: 0.300-0.821) were independent factors affecting the prevalence of congenital syphilis (all P < 0.05).  Conclusions  The incidence of congenital syphilis was closely related to the diagnosis period of syphilitic pregnant women, the non-treponema pallidum antigen serologic test result at the last test during pregnancy, treatment condition, the gestational age of delivery, the status of syphilis infection of husband/sexual partner and preventive treatment condition of exposed children. Early diagnosis, standardized treatment and preventive treatment of exposed children were beneficial to reduce the occurrence of congenital syphilis.
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  • 表  1  3 467例梅毒感染孕产妇的基本资料及所娩儿童发生母婴传播的情况[n(%)]

    Table  1.   Basic data of 3 467 syphilis-infected women and the incidence of mother-to-child transmission [n(%)]

    影响因素 调查例数 所娩儿童诊断先天梅毒
    否 是 χ2 P值
    分娩时期(年) 22.149 ＜0.001
      2015—2016 1 038(29.94) 984(94.80) 54(5.20)
      2017—2018 1 235(35.62) 1 200(97.17) 35(2.83)
      2019—2020 1 194(34.44) 1 173(98.24) 21(1.76)
    报告地区 18.269 ＜0.001
      鄂东区域 1 314(37.90) 1 251(95.21) 63(4.79)
      鄂中区域 710(20.48) 693(97.61) 17(2.39)
      鄂西区域 1 443(41.62) 1 413(97.92) 30(2.08)
    年龄(岁) 1.148 0.563
      ＜20 67(1.94) 65(97.01) 2(2.99)
      20~＜35 2 728(78.68) 2 637(96.66) 91(3.34)
      ≥35 672(19.38) 655(97.47) 17(2.53)
    民族 5.457 0.019
      汉族 3 155(91.00) 3 048(96.61) 107(3.39)
      其他 312(9.00) 309(99.04) 3(0.96)
    文化水平 0.267 0.875
      初中及以下 2 165(62.45) 2 095(96.77) 70(3.23)
      高中 969(27.95) 938(96.80) 31(3.20)
      大专及以上 333(9.60) 324(97.30) 9(2.70)
    职业类型 3.674 0.159
      家务及待业 1 639(47.27) 1 591(97.07) 48(2.93)
      农民 839(24.20) 804(95.83) 35(4.17)
      其他 989(28.53) 962(97.27) 27(2.73)
    婚姻状况 1.137 0.286
      非在婚 176(5.08) 168(95.45) 8(4.55)
      在婚 3 291(94.92) 3 189(96.90) 102(3.10)
    既往是否诊断为梅毒感染 2.749 0.097
      否 2 298(66.28) 2 217(96.48) 81(3.52)
      是 1 169(33.72) 1 140(97.52) 29(2.48)
    丈夫/性伴的梅毒感染情况 12.373 0.002
      未感染 513(14.80) 498(97.08) 15(2.92)
      感染 96(2.77) 87(90.62) 9(9.38)
      不详/未检测 2 858(82.43) 2 772(96.99) 86(3.01)
    孕次(次) 2.882 0.237
      1 936(27.00) 899(96.05) 37(3.95)
      2~3 1 814(52.32) 1 764(97.24) 50(2.76)
      ≥4 717(20.68) 694(96.79) 23(3.21)
    产次 11.296 0.001
      初产妇 1 215(35.04) 1 193(98.19) 22(1.81)
      经产妇 2 252(64.96) 2 164(96.09) 88(3.91)
    既往不良妊娠史 0.050 0.823
      无 2 678(77.24) 2 594(96.86) 84(3.14)
      有 789(22.76) 763(96.70) 26(3.30)
    孕产期异常情况 0.068 0.794
      无 3 145(90.71) 3 046(96.85) 99(3.15)
      有 322(9.29) 311(96.58) 11(3.42)
    分娩方式 1.144 0.564
      急诊剖宫产 698(20.13) 673(96.42) 25(3.58)
      阴道产 1 246(35.94) 1 204(96.63) 42(3.37)
      择期剖宫产 1 523(43.93) 1 480(97.18) 43(2.82)
    本次诊断梅毒感染的时期 40.230 ＜0.001
      产时/产后 894(25.79) 837(93.62) 57(6.38)
      孕前/孕期 2 573(74.21) 2 520(97.94) 53(2.06)
    本次诊断梅毒分期 12.711 0.002
      隐性 2 106(60.74) 2 056(97.63) 50(2.37)
      一期/二期/三期 175(5.05) 170(97.14) 5(2.86)
      不详 1 186(34.21) 1 131(95.36) 55(4.64)
    本次确诊时非梅试验效价 128.996 ＜0.001
      ≤1∶4 2 667(76.93) 2 606(97.71) 61(2.29)
      ≥1∶8 711(20.50) 683(96.06) 28(3.94)
      无滴度结果 89(2.57) 68(76.40) 21(23.60)
    孕期治疗情况 80.334 ＜0.001
      未治疗 924(26.65) 859(92.97) 65(7.03)
      一般治疗 837(24.14) 804(96.06) 33(3.94)
      规范治疗 1 706(49.21) 1 694(99.30) 12(0.70)
    治疗药物 66.923 ＜0.001
      未治疗 924(26.65) 859(92.97) 65(7.03)
      青霉素 2 466(71.13) 2 426(98.38) 40(1.62)
      红霉素/头孢类 77(2.22) 72(93.51) 5(6.49)
    妊娠末次非梅试验效价 18.620 ＜0.001
      阴性 318(9.17) 316(99.37) 2(0.63)
      ≤1∶4 1 057(30.49) 1 031(97.54) 26(2.46)
      ≥1∶8 204(5.88) 190(93.14) 14(6.86)
      不详 1 888(54.46) 1 820(96.40) 68(3.60)
    新生儿性别 3.247 0.072
      男 1 819(52.47) 1 752(96.32) 67(3.68)
      女 1 648(47.53) 1 605(97.39) 43(2.61)
    是否进行预防性治疗 31.903 ＜0.001
      是 2 594(74.82) 2 537(97.80) 57(2.20)
      否 873(25.18) 820(93.93) 53(6.07)
    足月产 14.583 ＜0.001
      否 372(10.73) 348(93.55) 24(6.45)
      是 3 095(89.27) 3 009(97.22) 86(2.78)
    下载: 导出CSV

    表  2  发生梅毒母婴传播的多因素logistic回归分析

    Table  2.   Multivariate logistic regression analysis of mother-to-child transmission of syphilis

    因素 β值 sx值 Wald值 OR(95% CI)值 P值
    本次诊断梅毒感染的时期
      孕前/孕期 1.000
      产时/产后 0.631 0.213 8.752 1.879(1.237~2.853) 0.003
    丈夫/性伴的梅毒感染情况
      未感染 1.000
      感染 1.325 0.478 7.671 3.762(1.473~9.608) 0.006
      不详/未检测 -0.070 0.305 0.053 0.932(0.512~1.696) 0.818
    妊娠末次非梅试验效价
      阴性 1.000
      ≤1∶4 1.389 0.753 3.400 4.011(0.916~17.558) 0.065
      ≥1∶8 2.187 0.805 7.385 8.908(1.840~43.131) 0.007
      不详 1.412 0.736 3.682 4.103(0.970~17.353) 0.055
    治疗情况
      规范治疗 1.000
      一般治疗 1.551 0.348 19.881 4.714(2.385~9.320) ＜0.001
      未治疗 1.850 0.332 30.996 6.360(3.316~12.199) ＜0.001
    暴露儿童预防性治疗
      否 1.000
      是 -0.582 0.211 7.581 0.559(0.369~0.846) 0.006
    足月产
      否 1.000
      是 -0.700 0.257 7.451 0.496(0.300~0.821) 0.006
    下载: 导出CSV
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  • 收稿日期:  2021-11-09
  • 修回日期:  2022-02-21
  • 网络出版日期:  2022-09-17
  • 刊出日期:  2022-09-10

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