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                    梅毒产妇早产发生率影响因素研究

                    时间:2019-03-21 来源:中国艾滋病性病 作者:盛健,吕亚慧,胡芳芳, 本文字数:6606字

                      摘    要:星云棋牌官网下载 目的 了解2013-2017年长春市妇产医院妊娠合并梅毒产妇早产发生情况,探讨梅毒产妇早产相关的影响因素,为梅毒产妇早产的防控及提高出生儿质量提供理论依据。方法 回顾性收集2013-2017年长春市妇产医院梅毒产妇病例资料,包括人口学资料、孕产信息和实验室检查结果等,计算5年的梅毒产妇早产发生率,并通过Logistic回归模型分析梅毒产妇早产发生的影响因素。结果 2013-2017年5年共收治梅毒产妇271例,45例发生早产,早产发生率为16.61%;单因素分析结果显示,年龄、现居住地、胎膜早破、梅毒快速血浆反应素环状卡片试验(RPR)等指标在早产组和非早产活产儿组分布的差异有统计学意义(P <0.05);Logistic回归模型分析显示,胎膜早破[比值比(OR)=3.519;95%可信区间(CI):1.160~10.675]、低血清白蛋白(OR=0.779;95%CI:0.673~0.901)、低血清钙(OR=0.003;95%CI:0.000~0.100)、高C-反应蛋白(OR=1.039;95%CI:1.009~1.069)、高RPR滴度(OR=9.427;95%CI:3.151~28.203)、高白细胞计数(OR=1.299;95%CI:1.114~1.515)是梅毒产妇早产发生的危险因素。结论 长春市妇产医院梅毒产妇早产发生率较高,梅毒产妇早产的发生受多种因素影响,孕期通过规范的抗梅毒治疗降低RPR滴度及积极预防胎膜早破将有助于降低早产的发生。

                      关键词: 梅毒; 产妇; 早产; 影响因素;

                      Abstract: Objective To analyze the premature birth of pregnant women with syphilis, and to explore the influencing factors related to premature delivery of syphilitic women, and to provide basis for prevention and control of preterm delivery among women with syphilis. Methods Data of maternal cases with syphilis was retrospectively collected from Changchun maternity hospital from 2013 to 2017, including their demographic data, maternity information, and laboratory test results, as well as the incidence of preterm delivery in syphilitic women in the 5 years. Logistic regression model was used to analyze the influencing factors. Results There were 271 cases of syphilis treated in the hospital during the time, with 45 cases(16.61%) of premature delivery. Univariate analysis showed that age, current residence, premature rupture of membranes, RPR(rapid plasma responsiveness test) and other factors were significantly different between the groups of preterm and non-preterm live births(P < 0.05). Logistic regression model analysis showed premature rupture of membranes(OR=3.519; 95% CI: 1.160-10.675), low serum albumin(OR=0.779; 95% CI: 0.673-0.901), low serum calcium(OR=0.003; 95% CI: 0.000-0.100), high C-reactive protein(OR=1.039; 95% CI: 1.009-1.069), high RPR titer(OR=9.427; 95% CI: 3.151-28.203) and high white blood cell count( OR=1.299; 95% CI: 1.114 to 1.515) were risk factors for preterm birth in syphilis. Conclusion The incidence of premature birth in syphilitic women in Changchun maternity hospital is high, which is affected by many factors. Standardized anti-syphilis treatment by reducing RPR titer and actively preventing premature rupture of membranes during pregnancy will help reduce the incidence of premature birth.

                      Keyword: syphilis; maternity; premature birth; influencing factor;

                      MEIDUSHIYIZHONGYOUMEIDULUOXUANTIGANRANRENTISUOYINQIDEMANXINGCHUANRANXINGJIBING[1],ZAIZHONGDUOXINGCHUANBOJIBINGZHONGQISUODAILAIDEWEIHAIJINCIYUAIZIBING[2],YICHENGWEIMUQIANSHIJIEGEGUOSUOGONGTONGMIANDUIDEZHONGDAGONGGONGWEISHENGWENTI[3,4]。JINNIANLAI,SUIZHEQUANRENQUNMEIDUJIANCHULVDEZENGJIA,RENSHENMEIDUDEJIANCHULVYEYOUZENGJIAQUSHI[5]。RENSHENMEIDUBUDANYINGXIANGYUNCHANFUDESHENXINJIANKANG,HAIHUIJIANGMEIDULUOXUANTITONGGUOTAIPANCHUIZHICHUANBOJITAIER,ZAOCHENGZAOCHAN、SITAI、LIUCHANYIJIXIANTIANMEIDUDENGDUOZHONGBULIANGRENSHENJIEJUDEFASHENG。YANJIUBIAOMING[6,7,8]:ZAOCHANCHANFU,SHENGYUHOUDAIXIEXINGJIBINGHEXINXUEGUANJIBINGHUANBINGFENGXIANHUIZENGJIA;SUOSHENGZAOCHANERWEISHENGQISIWANGLVZENGJIA,YIHUANGANRAN、XINSHENGERBAIXUEZHENG、NAOSUNSHANGDENGJIBING;JIBIANDAOLEERTONGQIJICHENGNIAN,ZAOCHANYIJIUHUISHIMANXINGBINGFABINGFENGXIANZENGJIA。WEILEYOUXIAOJIANGDIMEIDUCHANFUZAOCHANFASHENGLV,DUIQIFASHENGDEYINGXIANGYINSUJINXINGTANJIU。

                      1、 对象与方法

                      1.1 、对象

                      长春市妇产医院产科2013年1月1日至2017年12月31日间患梅毒的产妇。纳入标准:1)梅毒螺旋体明胶颗粒凝集试验(TPPA)和快速血浆反应素环状卡片试验(RPR)均为阳性;2)临床病历资料完整;3)单胎活产。排除标准:1)妊娠结局为死产、死胎、流产及多胎妊娠者;2)在意外情况下进行人工流产者;3)有家族遗传疾病及重大脏器疾患者。
                     

                    梅毒产妇早产发生率影响因素研究
                     

                      1.2、 方法

                      LIYONGZHANGCHUNSHIFUCHANYIYUANDEBINGLIXINXIGUANLIXITONGZILIAO,GENJUCHANFUXUEYESHENGHUAXUEZHIBIAOZHONGDERPRHETPPAZHIBIAOSHAIXUANCHUXIANGGUANBINGLI。CAIYONGZIXINGSHEJIDE《MEIDUCHANFUGEANDIAOCHABIAO》,YOUJINGGUOTONGYIPEIXUNDEDIAOCHARENYUANJINXINGHUIGUXINGSHOUJIMEIDUCHANFUBINGLIZILIAO。DIAOCHABIAODEZHUYAONEIRONGBAOKUO:NIANLING、MINZU、ZHIYE、JUZHUDIDENGYIBANRENKOUXUEZILIAO;TONGJINGSHI、LIUCHANSHI、YINCHANSHI、YUNCIDENGSHENGYUSHI;RENSHENQIHEBINGJIBING、YUNQIYICHANGZHENDUANDENGYUNQIQINGKUANG;MEIDUXUEQINGXUEJIANCEJIEGUO、XUECHANGGUI、GANGONGDENGSHENGHUAZHIBIAO;YUNQIKANGMEIDUZHILIAOQINGKUANGJIXINSHENGERJIBENXINXI。GENJUYANJIUJIEJUJIANGXUANZEDEDUIXIANGFENCHENGZHENGCHANGFENMIANZUHEZAOCHANZU。SHOUXIANJINXINGDANYINSUFENXI,TANJIUCHANFUDEGEXIANGYINSUZAILIANGZUZHIJIANDEFENBUDECHAYISHIFOUJUYOUTONGJIXUEYIYI。JIEJUZHIBIAOZAOCHANSHIZHICONGZUIHOUYICIYUEJINGDEDIYIRISUANQI,ZAIYUNZHOU≥28ZHOUQIE<37ZHOUFENMIANZHE[9]。ZAIYONGDIAOCHABIAOJINXINGZHENGSHIDEBINGLIXINXISHOUJIZHIQIAN,JINXINGCHONGFENDEYUDIAOCHA,SHIDIAOCHABIAONEIRONGGENGJIAWANSHAN。DUICUNZAIYIWENHEQUESHIDEBINGLIXINXI,ZHUIGENSUYUAN,CHAZHAOYUANSHIBINGLIZILIAOYIJIZIXUNXIANGGUANYISHI,QUEBAOZILIAOZHENSHIXINGHEKEKAOXING。

                      1.3、 统计分析

                    星云棋牌官网下载   DUISHOUJIHAOMEIDUCHANFULINCHUANGBINGLIXINXIDEDIAOCHABIAO,CAIYONGPINGXINGSHUANGLURUDEFANGFA,LURUEpi Date 3.1RUANJIAN,JINXINGYIZHIXINGJIANYAN,DUICUOWUDESHUJUJINXINGGENGZHENG,JIANLISHUJUKU。CAIYONGSPSS 24.0JINXINGSHUJUDECHULIHEFENXI。DANYINSUFENXIDEFANGFAGENJUZILIAODEBUTONGLEIXINGFENBIECAIYONGtJIANYAN、ZHIHEJIANYANHEKAFANGJIANYAN。JIANYANSHUIZHUNα=0.05。DUIYUDANYINSUCHUSHAIYOUYIYIDEZHIBIAOQUANBUNARUDAOERYUANFEITIAOJIANLogisticHUIGUIMOXINGCAIYONGXIANGQIANZHUBUHUIGUIDEFANGFAJINXINGDUOYINSUFENXI。

                      2 、结果

                      2.1 、一般情况

                      GONGSHOUJIDAO2013-2017NIANJIAN271LIMEIDUCHANFUDEQUANBUBINGLIXINXI,QIZHONGZAOCHAN45LI,ZAOCHANFASHENGLVWEI16.61%。CHUQURENSHENJIEJUWEILIUCHAN(14LI)HESITAI(27LI),ZUIZHONGRENSHENJIEJUWEIHUOCHANDEMEIDUCHANFU230LI,JIANGQIFENWEIZAOCHANZU(45LI)HEZHENGCHANGFENMIANZU(185LI)。230LIMEIDUCHANFUZHONGNIANLINGZUIDA43SUI,ZUIXIAO17SUI,NIANLING25~29SUIZHE90LI(39.13%);HANZU218LI(94.78%);WUZHIYEZHE172LI(74.78%);JUZHUDICHENGSHI130LI(56.52%)。

                      2.2、梅毒产妇早产发生的单因素分析

                      NIANLING、XIANJUZHUDI、YUEJINGCHUCHAONIANLING、TAIMOZAOPO、RENSHENQISHIFOUJINXINGKANGMEIDUZHILIAO、RPRDIDU(GAODIDUZU:RPR≥1∶16;DIDIDUZU:RPR≤1∶8)、BAIXIBAOJISHUHEC-FANYINGDANBAIDENGZHIBIAOZAIZHENGCHANGFENMIANZUHEZAOCHANZUFENBUDECHAYIYOUTONGJIXUEYIYI(P<0.05)。XIANGJIANBIAO1。

                      2.3、 梅毒产妇早产发生的多因素Logistic回归分析

                    星云棋牌官网下载   YIMEIDUCHANFUSHIFOUFASHENGZAOCHANWEIYINBIANLIANG(1=FOU,2=SHI),YINIANLING、JUZHUDI、YUEJINGCHUCHAONIANLING、SHIFOUFASHENGTAIMOZAOPODENG25GEYINSUWEIZIBIANLIANGJINXINGDUOYINSULogisticHUIGUIFENXI,XIANGJIANBIAO2。JIEGUOXIANSHI:TAIMOZAOPO[BIZHIBI(OR)=3.519;95%KEXINQUJIAN(CI):1.160~10.675]、GAOC-FANYINGDANBAI(OR=1.039;95%CI:1.009~1.069)、RPRGAODIDU(OR=9.427;95%CI:3.151~28.203)YIJIGAOBAIXIBAOJISHU(OR=1.299;95%CI:1.114~1.515)SHIMEIDUCHANFUFASHENGZAOCHANDEWEIXIANYINSU;GAOXUEQINGBAIDANBAI(OR=0.779;95%CI:0.673~0.901)HEGAOXUEQINGGAI(OR=0.003;95%CI:0.000~0.100)SHIMEIDUCHANFUZAOCHANFASHENGDEBAOHUYINSU。

                      

                      表1 梅毒产妇早产发生的因素分析
                    表1 梅毒产妇早产发生的因素分析
                    表1 梅毒产妇早产发生的因素分析

                      表2 梅毒产妇发生早产多因素非条件Logistic回归分析结果
                    表2 梅毒产妇发生早产多因素非条件Logistic回归分析结果

                      ZHU:RPRDIDUSHIYIRPR≤1∶8WEIDUIZHAO。

                      3、 讨论

                      ZAOCHANZUOWEIWEICHANYIXUEZHONGJIAOWEICHANGJIANDERENSHENBINGFAZHENG,SHIWEICHANERFABINGJISIWANGBUKEHUSHIDEZHONGYAOYUANYIN,QINENGGOUDAILAIJUDADEGONGGONGWEISHENGFUDAN[10]。ZAOCHANDEFASHENGLVZAIBUTONGDIYU、GUOJIAHEZHONGZUDOUCUNZAIZHEJIAODADECHAYI,DUIYUWOGUOXIANJIEDUANGUANYURENQUNZAOCHANDEFASHENGQINGKUANGDEBAODAOHAIBUGOUQUANMIAN,BAODAOJIEGUOBUYI[11,12]。RUGUOYUNQIHUANYOUMEIDU,QIBINGYUANTIMEIDULUOXUANTIKETONGGUOQIDAIXUEYEJINRUTAIERTINEI,LEIJITAIERPI、YIHEGANDENGDUOQIGUANZANGQIHUOZHIJIEGANRANTAIPANYINQIXIAODONGMAINEIMOYAN,CONGERDAOZHIXINSHENGERDUOZHONGJIBINGFASHENGNAIZHISIWANG[13,14]。ZHONGDUODEYANJIUJUNBIAOMINGRENSHENHEBINGMEIDUJIANGHUIDUIRENSHENJIEJUCHANSHENGYANZHONGBULIANGYINGXIANG,BAOKUOXINSHENGERXIANTIANMEIDU、SITAI、DICHUSHENGTIZHONGERYIJIZAOCHANDENG[15,16,17,18]。

                      BENYANJIUZHONGRENSHENMEIDUCHANFUZAOCHANFASHENGLVGAOYUZHONGHUAYIXUEHUIZAIZAOQIDUIWOGUOBUFENCHENGSHIZAOCHANERFASHENGLVDELIUXINGBINGXUEDIAOCHAJIEGUO[11],YIJIZHAOJINQIDENG[19]BAODAODE2011-2016NIANBEIJINGZAOCHANDEFASHENGQINGKUANG,YEGAOYUQINJIABI[16]DEYIPIANMetaFENXIBAODAODEMEIDUCHANFUZAOCHANFASHENGLV。YANJIUJIEGUOXIANSHIRPRDIDUGAODEMEIDUHUANZHEXUEYEZHONGKANGXINLIANZHIKANGTIHANLIANGGAO,ZHEIJIUYIWEIZHEBEIMEIDULUOXUANTIPOHUAIDEXIBAOGENGDUO,JIANGHUIGENGZAOZAOCHENGTAIPANSUNSHANG,CONGERDAOZHIZAOCHANDENGRENSHENBULIANGJIEJUDEFASHENG[20]。GENJUChangalcucha JDENG[21,22]BAODAO,YUFEIMEIDUGANRANCHANFUBIJIAO,XUEQINGRPRGAODIDUMEIDUGANRANSHICHANFUFASHENGZAOCHAN、SITAIDENGBULIANGRENSHENJIEJUDEWEIXIANYINSU。DENGXIAODENG[23]DUISHANGHAISHIJIADINGQU2012-2015NIAN267LIRENSHENHEBINGMEIDUYUZAOCHANFASHENGGUANXIDEYANJIUZHONG,TONGYANGFAXIANMEIDUXUEQINGDIDUGAODECHANFUGENGYIFASHENGZAOCHAN。DUIYUYUNCHANFUYINGJINXINGGUIFANDEYUNJIAN,YUNQIYUEZAOFAXIAN、YUEZAOGUIFANDEJINXINGKANGMEIDUZHILIAO、MEIDUXUEQINGXUEDIDUJIUYUEDI,QIZAOCHANFASHENGLVYUEDI,TICHANGJIJIKONGZHIMEIDUYUNFURPRDIDUSHIQIJIANGZHIZHENGCHANGHUOJIAODISHUIPINGHOUZAIKAOLVRENSHENHEFENMIAN[24,25,26]。TAIMOZAOPOSHIZHIYUNFUZAISHENGCHANQIANCHUXIANTAIMOZIRANPOLIEDEXIANXIANG,SHUYUYUNFUWEISHENGQICHANGJIANBINGFAZHENG,DUITAIERZAOCHANYIJIBINGSIYOUHENDAYINGXIANG[27]。BENYANJIUZHONGMEIDUCHANFUTAIMOZAOPOFASHENGLVGAOYUCAOLUFENGDENG[28]HEZHANGRUIXUEDENG[29]DUIZHENGCHANGRENQUNTAIMOZAOPOFASHENGLVDEBAODAO。ZHEIHEAlberico SDENG[30,31]BAODAODEGANRANHUIZENGJIAYUNCHANFUTAIMOZAOPOFASHENGXIANGYIZHI。TISHIQIANGHUAYUNQIAN、YUNQIJIANCHA,JIJIJINXINGKANGMEIDUZHILIAO,ZAOQIJIANCHAYUFANGTAIMOZAOPONENGYOUXIAOJIANGDIZAOCHANDEFASHENG。YIWANGDEYANJIUJUNBIAOMING,RENSHENMEIDUHUANZHEYUNQIKANGMEIDUZHILIAOQINGKUANGSHIZAOCHANDENGBULIANGRENSHENJIEJUDEYINGXIANGYINSU[16,20,32],ERDUIYUBENYANJIUZHONGCIXIANGYINSUBINGWEIJINRUZUIZHONGDEDUOYINSULogisticHUIGUIMOXING,KENENGDEYUANYINSHIBENCIYANJIUDEDUIXIANGSHIMEIDUCHANFU,DUIYUQIYUNQIKANGMEIDUZHILIAOSHISHIGENJUHUANZHEBENRENDEZISHU,YOUCUNZAIHUIYIPIANCHAHUOZHEGUYIYINMANDEKENENG。JINNIANLAI,DUIRENSHENHEBINGMEIDUZAOCHANDENGBULIANGRENSHENJIEJUDEYANJIUGENGDUODESHIJUXIANYUHUANZHEDEYIBANRENKOUXUEZILIAO、YUNCHANSHIHEYUNQILINCHUANGTEZHENGDENGDINGXINGZILIAO,ERDUIYUQIXUECHANGGUI、GANGONGDENGZHUDUOXUESHENGHUADINGLIANGZILIAODEYANJIUSHENSHAO,DUIYUBENYANJIUZHONGGUANYUXUEYESHENGHUAXUEZHIBIAOYUZAOCHANGUANXISUODECHUDEJIELUNHAIXUYAOZUOJINYIBUDETANTAO。

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                      论文来源参考:盛健,吕亚慧,胡芳芳,雒静静.妊娠合并梅毒患者早产发生的影响因素分析[J].中国艾滋病性病,2020,26(02):183-186.
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