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中国防痨杂志 ›› 2021, Vol. 43 ›› Issue (7): 682-688.doi: 10.3969/j.issn.1000-6621.2021.07.008

• 论著 • 上一篇    下一篇


覃瑶, 蔡青山, 鲍志坚()   

  1. 310000 浙江大学医学院附属杭州市胸科医院结核科
  • 收稿日期:2021-01-11 出版日期:2021-07-10 发布日期:2021-07-09
  • 通信作者: 鲍志坚
  • 基金资助:

Analysis of clinical characteristics and prognosis of 21 pregnant women complicated with tuberculosis after in vitro fertilization-embryo transfer

QIN Yao, CAI Qing-shan, BAO Zhi-jian()   

  1. Department of Tuberculosis, Hangzhou Chest Hospital, Zhejiang University School of Medicine, Hangzhou 310000, China
  • Received:2021-01-11 Online:2021-07-10 Published:2021-07-09
  • Contact: BAO Zhi-jian

摘要: 目的 总结分析体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)后妊娠并发结核病患者的临床特点。 方法 回顾性分析2013年1月至2020年12月浙江大学医学院附属杭州市胸科医院结核科收治的IVF-ET后妊娠并发结核病的21例患者的临床资料,对临床症状、就诊情况、实验室检查、影像学特征、临床诊断、治疗转归及胎儿结局进行分析。 结果 IVF-ET后妊娠并发结核病的21例患者中,早期妊娠8例,中期妊娠13例;年龄23~42岁,平均(29.57±4.20)岁;临床多以发热(95.2%,20/21)、咳嗽(85.7%,18/21)及阴道出血(71.4%,15/21)为主要表现。21例患者均存在不同程度的就诊延迟,最长延迟90d,初诊误诊率达100.0%,确诊时间21(15,30)d。18例行外周血结核感染T细胞斑点试验检测均为阳性,4例行GeneXpert MTB/RIF检测均为阳性;20例患者存在贫血,21例患者存在低蛋白血症。18例胸部影像学表现以双肺粟粒样结节改变为主。18例诊断为血行播散性肺结核,其中2例并发结核性脑膜炎,1例并发结核性腹膜炎;1例诊断为亚急性血行播散性肺结核;1例诊断为结核性脑膜炎;1例诊断为结核性胸膜炎。治疗过程中有4例因出现呼吸衰竭转入ICU,1例因电解质紊乱转入ICU,1例因意识不清转入ICU。9例患者在发病后9~20周内发生先兆流产,或难免流产,或不完全流产;11例行人工流产终止妊娠(包括1例昏迷患者);1例要求保胎,随后失访。21例患者均行抗结核治疗,19例好转出院后进行门诊服药并治愈,1例处于抗结核治疗中,1例因结核性脑膜炎处于昏迷中。 结论 IVF-ET后妊娠并发结核病患者多并发血行播散性肺结核和肺外结核,病情多较严重。当妊娠患者出现发热、咳嗽、阴道出血、头痛,且抗感染治疗效果欠佳时,应及时进行结核病的相关检查。

关键词: 受精, 体外, 胚胎移植, 结核, 妊娠, 治疗结果

Abstract: Objective To analyze the clinical characteristics of pregnant women complicated with tuberculosis after in vitro fertilization-embryo transfer (IVF-ET). Methods Clinical data, including the clinical manifestation, medical information, laboratory examinations, imaging features, clinical diagnosis, treatment outcome and fetal outcome, of 21 pregnant women complicated with tuberculosis after IVF-ET admitted to the Tuberculosis Department of Hangzhou Chest Hospital, Zhejiang University School of Medicine from January 2013 to December 2020 were retrospectively analyzed. Results Among the 21 patients, 8 were in early pregnancy and 13 were in second trimester, with an average age of (29.57±4.20) years old (ranged from 23 to 42 years old). The most common clinical symptoms were fever (95.2%, 20/21), cough (85.7%, 18/21) and vaginal bleeding (71.4%, 15/21). Patient delay was found in all the 21 patients, the longest delay was 90 days, and the misdiagnosis rate of the first diagnosis was 100.0%, the average diagnosis time was 21 days (ranged from 15 to 30 days). T-SPOT.TB in peripheral blood was positive in 18 patients, sputum/cerebrospinal fluid GeneXpert MTB/RIF was positive in 4 patients; 20 patients had anemia, and 21 patients had hypoproteinemia. Chest CT scan mainly showed miliary nodules in both lungs in 18 cases. Eighteen patients were diagnosed with hematogenous disseminated tuberculosis, of whom two were complicated with tuberculous meningitis, one was complicated with tuberculous peritonitis; one was diagnosed as subacute disseminated tuberculosis; one was diagnosed with tuberculous meningitis; one was diagnosed with tuberculous pleurisy. During the treatment, six patients were transferred to ICU, four were due to respiratory failure, one was due to electrolyte disorder, and one was due to unconsciousness. Threatened abortion, inevitable abortion or incomplete abortion occurred in 9 cases 9-20 weeks after onset; 11 cases underwent induced abortion to terminate pregnancy, including one coma patient; one patient asked for fetal protection and was lost to follow-up. All the 21 patients underwent anti-tuberculosis treatment, 19 were cured after being discharged from hospital, one was still in anti-tuberculosis treatment, and one was in coma due to tuberculous meningitis. Conclusion Hematological disseminated tuberculosis and extra-pulmonary tuberculosis were commonly occurred in pregnant patients with tuberculosis after IVF-ET, and the conditions were always serious. When fever, cough, vaginal bleeding, headache occurred, and the anti-infective treatment effect was not good, tuberculosis related examinations should be carried out in time for pregnant patients.

Key words: Fertilization in vitro, Embryo transfer, Tuberculosis, Pregnancy, Treatment outcome