28例体外受精-胚胎移植后妊娠并发结核病患者临床特征及母婴结局

doi:10.19983/j.issn.2096-8493.2024127

摘要/Abstract

摘要：

目的: 了解体外受精-胚胎移植后妊娠并发结核病患者临床特征及母婴结局。方法: 回顾性纳入成都市公共卫生临床医疗中心2012年5月至2024年5月期间收治的体外受精-胚胎移植后妊娠并发结核病患者共计28例的临床资料,对患者的临床特征、母婴结局进行描述性分析。结果: 28例患者平均年龄为(31.1±3.6)岁,妊娠时间[中位数(四分位数)]为108.0(84.0,141.0)d,早期妊娠9例(32.1%),中期妊娠19例(67.9%)。28例患者以发热(27例)、咳嗽(24例)、气促(20例)、阴道流血(17例)为主要临床表现。有27例(96.4%)患者为血行播散性肺结核,合并肺外结核15例(53.6%),其中,结核性脑膜炎14例(50.0%),同一例患者同时患≥3种类型结核病者10例(35.7%)。28例患者中结核病病原学阳性者13例(46.4%),耐药患者2例,分别为利福平耐药及准广泛耐药。实验室检查:血红蛋白为(98.6±12.4)g/L,血清白蛋白为(30.7±4.6)g/L,CD4⁺T淋巴细胞计数为212.5(125.0,319.5)个/μl。28例患者中气管插管有创机械通气3例(10.7%),无创呼吸机13例(46.4%),截至2024年7月治疗成功21例(75.0%),死亡1例,6例尚在治疗过程中,目前均好转。在治疗期间13例(53.8%)患者发生了不良反应,包括7例(25.0%)肝功能损伤、4例(14.3%)骨髓抑制、2例(7.1%)药物性皮疹,1例(3.6%)药物热。28例患者共孕43名胎儿,5例自然流产,其余均人工终止妊娠。结论: 体外受精-胚胎移植后妊娠并发结核病患者以发热及呼吸道症状为主,重症结核病发生率高,通过积极有效的抗结核治疗大多预后良好,该类患者应重视产前结核病筛查,产后密切监测,提高诊断准确率。

关键词: 受精,体外, 胚胎移植, 结核, 疾病特征, 预后

Abstract:

Objective: To evaluate the clinical characteristics and maternal and neonatal outcomes of pregnancies complicated by tuberculosis following in vitro fertilization-embryo transfer (IVF-ET). Methods: A retrospective analysis was conducted on clinical data from 28 cases of pregnancies complicated by tuberculosis after IVF-ET, admitted to the Public Health Clinical Medical Center between May 2012 and May 2024. The clinical characteristics and maternal and neonatal outcomes were descriptively analyzed. Results: The mean age of the 28 patients was (31.1±3.6) years, with a median gestational period of 108.0 days (interquartile range: 84.0-141.0 days). Among these cases, 9 (32.1%) were in early pregnancy and 19 (67.9%) were in the mid-trimester. The primary clinical manifestations included fever (27 cases), cough (24 cases), shortness of breath (20 cases), and vaginal bleeding (17 cases). Hematogenous disseminated pulmonary tuberculosis was observed in 27 patients (96.4%), while 15 patients (53.6%) had extrapulmonary tuberculosis, and 14 (50.0%) were diagnosed with tuberculous meningitis. Additionally, 10 patients (35.7%) presented with three or more types of tuberculosis simultaneously. Among the 28 patients, 13 (46.4%) tested positive for tuberculosis etiology, and 2 patients had drug-resistant tuberculosis (rifampicin-resistant and pre-extensively drug-resistant tuberculosis). Laboratory examinations showed a mean hemoglobin level of (98.6±12.4) g/L, a mean serum albumin level of (30.7±4.6)g/L, and a median CD4⁺ T-cell count of 212.5 cells/μl (interquartile range: 125.0-319.5 cells/μl). Of the 28 patients, 3 (10.7%) required tracheal intubation with invasive mechanical ventilation, while 13 (46.4%) used non-invasive ventilatory support. By July 2024, 21 patients (75.0%) had successfully completed treatment, 1 patient had died, and 6 patients were still undergoing treatment, all of whom were showing improvement. Adverse reactions were noted in 13 patients (53.8%) during treatment, including 7 cases (25.0%) of liver function injury, 4 cases (14.3%) of bone marrow suppression, 2 cases (7.1%) of drug-induced rash, and 1 case (3.6%) of drug fever. A total of 43 fetuses were conceived by the 28 patients, with 5 resulting in spontaneous abortions, and the remainder undergoing elective termination. Conclusion: The majority of pregnant patients with tuberculosis following in vitro IVF-ET present with fever and respiratory symptoms, and the incidence of severe tuberculosis is notably high. Most patients achieve a favorable prognosis with prompt and effective anti-tuberculosis treatment. Emphasis should be placed on prenatal tuberculosis screening and close postpartum monitoring to enhance diagnostic accuracy.

Key words: In vitro fertilization, Embryo transfer, Tuberculosis, Clinical characteristics, Prognosis

中图分类号:

R714.2
R52

赖敏, 吴桂辉, 陈洪德, 李洪梅, 郭周莉, 王新伟. 28例体外受精-胚胎移植后妊娠并发结核病患者临床特征及母婴结局[J]. 结核与肺部疾病杂志, 2024, 5(6): 540-545. doi: 10.19983/j.issn.2096-8493.2024127

Lai Min, Wu Guihui, Chen Hongde, Li Hongmei, Guo Zhouli, Wang Xinwei. Clinical characteristics and maternal and neonatal outcomes of 28 cases of pregnancies complicated with tuberculosis after in vitro fertilization-embryo transfer[J]. Journal of Tuberculosis and Lung Disease, 2024, 5(6): 540-545. doi: 10.19983/j.issn.2096-8493.2024127

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