摘要目的 了解感染梅毒产妇在确诊后及孕期接受治疗的情况,并进一步探讨相关影响因素. 方法 选择在深圳市各助产机构接受产前保健服务、确诊感染梅毒、确诊时间为2012年1月1日至2014年12月31日、年龄≥18岁、经随访有分娩结局且自愿参加调查的感染梅毒产妇为研究对象,采用结构化问卷收集研究对象的一般人口学信息、疾病信息、治疗信息及相关妊娠结局等.单因素分析采用x2检验,多因素分析采用二分类logistic回归模型(向前逐步回归法). 结果 本研究共纳入感染梅毒产妇1 748例,其中167例(9.55％)未治疗(包括104例因孕前已规范治疗而未在此次孕期接受治疗,51例因其他原因拒绝治疗,12例治疗情况记录不详);1 581例(90.45％)在确诊后接受了治疗,其中1 294例孕期治疗,287例临产时/分娩后治疗.单因素分析结果显示,产妇的现住址、在深圳居住时间、首次产前检查孕周、梅毒抗体血清滴度、疾病诊断和接受免费治疗情况与产妇在确诊后是否接受治疗相关(x2值分别为7.24、8.82、41.62、16.77、102.01及14.84,P值均＜0.05);产妇的年龄、现住址、在深圳居住时间、职业、首次产前检查孕周、疾病诊断年份、产前检查机构类别、产前检查机构所在地和接受免费治疗情况与产妇是否在孕期接受治疗相关(x2值分别为10.93、30.40、21.10、22.13、664.85、12.36、23.31、46.12及24.41,P值均＜ 0.05).多因素分析结果显示,与文化水平为本科及以上的产妇相比,高中及以下文化水平产妇的确诊后治疗及孕期治疗OR值(95％CI)分别为1.87(1.13～3.10)和1.81 (1.14～2.87);与首次产前检查孕周≤12周的产妇相比,首次产前检查孕周＞12～≤27周、＞27～≤36周和＞36周产妇的确诊后治疗OR值(95％CI分别为0.50(0.31～0.80)、0.38(0.20～0.73)和0.16(0.09～0.27),而孕期治疗OR值(95％CI)分别为0.62(0.42～0.90)、0.17 (0.11～0.26)和0.01(0.01～0.02);与疾病诊断为隐性梅毒的产妇相比,足量治疗后产妇的确诊后治疗OR值(95％CI)为0.18(0.13～0.26);与梅毒抗体血清滴度≤1∶4的产妇相比,滴度≥1∶8产妇的确诊后治疗OR值(95％CI)为1.74(1.02～2.96);与产前检查机构所在地在深圳关内的产妇相比,产前检查机构在关外的产妇的孕期治疗OR值(95％CI)为0.64(0.45～0.92);与未接受免费治疗服务的产妇相比,接受免费治疗产妇的孕期治疗OR值(95％CI)为2.41(1.07～5.41). 结论 深圳市感染梅毒产妇的治疗率相对较高,但存在拒绝治疗及分娩后才接受治疗的情况.感染梅毒产妇的治疗情况受其文化水平、疾病情况、产前检查情况及免费治疗服务等影响.

abstractsObjective To investigate the treatment status of syphilitic mothers,and the factors associated with receiving treatment after being diagnosed (RTABD) and receiving treatment during pregnancy (RTDP).Methods Women aged ≥ 18 years who received prenatal care in Shenzhen obstetric centers,were diagnosed with syphilis between January 1,2012 and December 31,2014,had childbirth outcomes and agreed to participate in the study were recruited.Information on participants' demographic characteristics,disease condition,treatment status and pregnancy outcomes were obtained using a structured questionnaire.Univariate analysis was performed with Chi-square test,and multivariate analysis was performed with the binary logistic regression model (forward stepwise regression method).Results A total of 1 748 syphilitic mothers who fulfilled the inclusion criteria were recruited.Of these cases,167 cases (9.55％) did not receive treatment (including 104 cases who had adequate treatment before pregnancy but no treatment during pregnancy,51 cases refused treatment and 12 cases had no record of treatment),and 1 581(90.45％) RTABDs with syphilis.Of these 1 581 cases,1 294 RTDPs and 287 received treatment during or after childbirth.Maternal living address,duration of residence in Shenzhen,gestational week at the first antenatal visit,disease stage,serological titer and utilization of free treatment services were associated with RTABD (x2=7.24,8.82,41.62,16.77,102.01 and 14.84,all P＜0.05),and maternal age,living address,duration of residence in Shenzhen,profession,gestational week at the first antenatal visit,year of syphilis diagnosis,category and address of antenatal clinics,and utilization of free treatment services were associated with RTDP (x2=10.93,30.40,21.10,22.13,664.85,12.36,23.31,46.12 and 24.41,all P＜0.05).Compared to mothers with college or above education,the OR (95％CI) was 1.87 (1.13-3.10) and 1.81 (1.14-2.87) for RTABD and RTDP,respectively,in mothers with senior high school or below education.The OR (95％CI) was 0.50 (0.31-0.80),0.38 (0.20-0.73) and 0.16 (0.09-0.27) for RTABD,and was 0.62 (0.42-0.90),0.17 (0.11-0.26) and 0.01 (0.01-0.02) for RTDP in mothers whose first antenatal visit was at ＞12-≤27 gestational weeks,＞27-≤ 36 gestational weeks,and ＞36 gestational weeks,respectively,when compared to those visiting at ≤ 12 gestational weeks.The OR (95％CI) was 0.18 (0.13-0.26) for RTABD in mothers with latent syphilis when compared to those treated before pregnancy.The OR (95％CI) was 1.74 (1.02-2.96) for RTABD in mothers with a serological titer ≥ 1 ∶ 8,when compared to those with a serological titer ≤ 1 ∶ 4.The OR (95％CI) was 0.64 (0.45-0.92) for RTDP in mothers who received prenatal care in Baoan,Longgang,Guangming,Pingshan,Longhua and Dapeng districts,when compared to those receiving prenatal care in Luohu,Futian,Nanshan and Yantian districts.The OR (95％CI) was 2.41 (1.07-5.41) for RTDP in mothers who accepted free treatment services,when compared to those paying for treatment themselves.Conclusions The percentage of RTABD is high among syphilitic mothers in Shenzhen.However,some mothers still refuse to accept treatment and some receive treatment after childbirth.Mothers' education level,disease condition,utilization of prenatal care services and free treatment services are associated with RTABD and/or RTDP.