上海闸北地区妊娠梅毒分子流行病学特征分析

doi:10.3969/j.issn.1673-8640.2016.06.010

摘要/Abstract

摘要：

目的分析闸北地区孕产妇梅毒的发病率、垂直传播、分子分型等流行病学特征,探讨分子分型的改变及各类样本对检测结果的影响。方法对3 022例孕产妇进行梅毒筛查,阳性者采集全血、血浆、耳垂血及皮损分泌物样本进行分子分型;并收集临床资料,分析发病率、母婴传播及社会学资料。结果共筛查出阳性病例41例,阳性率为 1.32%,梅毒垂直传播比例为 43.9%（18/41）,14d/f型（80.9%,17/21）为临床验证样本中最常见的基因型别,15d/f型、13a/f型、13d/f型和9o/c型各1例（4.7%,1/21）。各类样本中以皮损分泌物样本分型效率最高,耳垂血样本略低于皮损分泌物样本,显著高于全血和血浆样本。结论闸北地区妊娠梅毒发病率高于上海平均水平,其分子分型多样,加强对孕产妇管理十分必要。耳垂血可能是研究潜伏性梅毒的一个较好的样本。

关键词: 梅毒螺旋体, 分子分型, 母婴传播, 耳垂血

Abstract:

Objective To evaluate the incidence,maternal-neonatal transmission and genotype of syphilis in pregnant women from Zhabei District,and to investigate the influence of genotype change and specimen on determination results. Methods A total of 3 022 pregnant women were enrolled for syphilis screening. The specimens were collected from whole blood,plasma,ear lobe blood and skin of syphilis-positive patients for genotype determination. Clinical data were collected to evaluate incidence,maternal-neonatal transmission and social factors. Results A total of 41 pregnant women were positive in syphilis screening,and the positive rate was 1.32%. The proportion of maternal-neonatal transmission accounted for 43.9%（18/41）. The predominant type was 14d/f （80.9%,17/21）,followed by 15d/f（4.7%,1/21）,13a/f（4.7%,1/21）,13d/f（4.7%,1/21） and 9o/c（4.7%,1/21）. Genotyping efficiency of skin was the highest,and that of ear lobe blood was lower than that of skin,which were higher than those of whole blood and plasma. Conclusions The incidence of syphilis in pregnant women in Zhabei District is higher than that in Shanghai,and the kinds of genotypes are various. Ear lobe blood is a good choice of specimen for genotyping.

Key words: Treponema pallidum, Genotype, Maternal-neonatal transmission, Ear lobe blood

中图分类号:

R446.5

吴奇, 王丽, 季灵婷, 吕盈盈. 上海闸北地区妊娠梅毒分子流行病学特征分析[J]. 检验医学, 2016, 31(6): 486-490.

WU Qi, WANG Li, JI Lingting, L Yingying. Molecular epidemiological analysis for pregnant women with syphilis in Zhabei District of Shanghai[J]. Laboratory Medicine, 2016, 31(6): 486-490.

图/表 7

参考文献 13

[1]	上海市卫生和计划生育委员会. 疫情信息[EB/OL].(2015-03-06)[2015-06-18]. http://www.wsjsw.gov.cn/wsj/n429/n426/u1ai135364.html.
[2]	陆海空,周平玉. 我国梅毒治疗及梅毒耐药现况[J]. 上海医药,2012,33(1):8-10.
[3]	CHEN ZQ,ZHANG GC,GONG XD,et al.Syphilis in China:results of a national surveillance programme[J]. Lancet,2007,369(9556):132-138.
[4]	MARRA C,SAHI S,TANTALO L,et al.Enhanced molecular typing of treponema pallidum:geographical distribution of strain types and association with neurosyphilis[J]. J Infect Dis,2010,202(9): 1380-1388.
[5]	MIKALOVA L,POSPISILOVA P,WOZNICOVA V,et al.Comparison of CDC and sequence-based molecular typing of syphilis treponemes: tpr and arp loci are variable in multiple samples from the same patient[J]. BMC Microbiol,2013,13:178-182.
[6]	戴婷. 上海地区梅毒患者梅毒螺旋体基因分型及与神经梅毒相关性的初步研究[D]. 北京:北京协和医学院,2012.
[7]	TIPPLE C,TAYLOR GP.Syphilis testing,typing,and treatment follow-up: a new era for an old disease[J]. Curr Opin Infect Dis,2015,28(1):53-60.
[8]	GRILLOVA L,PTROSVA H,MIKALOVA L,et al.Molecular typing of Treponema pallidum in the Czech Republic during 2011 to 2013:increased prevalence of identified genotypes and of isolates with macrolide resistance[J]. J Clin Microbiol,2014,52(10):3693-3700.
[9]	彭锐锐. 早期梅毒的分子流行病学研究:我国多地区性病门诊的横断面调查[D]. 北京:北京协和医学院,2012 .
[10]	GAYET-AGERON A,LAURENT F,SCHRENZEL J,et al.Performance of the 47-kilodalton membrane protein versus DNA polymerase i genes for detection of Treponema pallidum by PCR in ulcers[J]. J Clin Microbiol,2015,53(3):976-980.
[11]	WU BR,YANG CJ,TSAI MS,et al.Multicentre surveillance of prevalence of the 23S rRNA A2058G and A2059G point mutations and molecular subtypes of Treponema pallidum in Taiwan,2009-2013[J]. Clin Microbiol Infect,2014,20(8):802-807.
[12]	PENG RR,WANG AL,LI J,et al.Molecular typing of Treponema pallidum: a systematic review and meta-analysis[J]. PLoS One,2011,5(11):e1273.
[13]	CASTRO R,PRIETO E,AGUAS MJ,et al.Molecular subtyping of Treponema pallidum subsp. pallidum in Lisbon,Portugal[J]. J Clin Microbiol,2009,47(8):2510-2512.

基因名称	引物序列
tp47	F： CGTGTGGTATCA ACTATGG R： TCA ACCGTGTACTCAGTGC
arp	F：CAAGTCAGGACGGACTGTCC R：GGTATCACCTGGGGATGC
tpr	F：CAGGTTTTGCCGTTAAGC R：AATCAAGGGAGAATACCGTC
tp0548	F：GGTCCCTATGATATCGTGTTCG R：GTCATGGATCTGCGAGTGG

基因名称	引物序列
tp47	F： CGTGTGGTATCA ACTATGG R： TCA ACCGTGTACTCAGTGC
arp	F：CAAGTCAGGACGGACTGTCC R：GGTATCACCTGGGGATGC
tpr	F：CAGGTTTTGCCGTTAAGC R：AATCAAGGGAGAATACCGTC
tp0548	F：GGTCCCTATGATATCGTGTTCG R：GTCATGGATCTGCGAGTGG

年龄（岁）	例数	妊娠结局				新生儿梅毒阳性	合并HIV感染
年龄（岁）	例数	足月活产	早产	死胎	畸形	新生儿梅毒阳性	合并HIV感染
20~29	28	24	3	1	0	13	0
30~39	11	9	1	1	0	4	0
40~49	2	1	1	0	0	1	0

年龄（岁）	例数	妊娠结局				新生儿梅毒阳性	合并HIV感染
年龄（岁）	例数	足月活产	早产	死胎	畸形	新生儿梅毒阳性	合并HIV感染
20~29	28	24	3	1	0	13	0
30~39	11	9	1	1	0	4	0
40~49	2	1	1	0	0	1	0

梅毒分期	例数	全血	血浆	耳垂血	皮损分泌物
一期	8	3/8	4/8	6/8^{* #}	7/8^{* #}
二期	3	2/3	2/3	3/3^*	3/3^*
潜伏期	30	8/30	11/30	16/28^*
合计	41	13/41	17/41	25/39^*	10/11^{* #}