围产期母婴李斯特菌病13例临床分析  

Perinatal listeriosis: report of 13 cases

作　　者：贾忠兰[1] 许丽风[1] 王青[1] 高志慧[1] 

机构地区：[1]北京市海淀区妇幼保健院检验科,北京100080

出　　处：《中国感染与化疗杂志》2016年第1期33-40,共8页Chinese Journal of Infection and Chemotherapy

摘　　要：目的探讨围产期孕产妇及新生儿感染李斯特菌病的临床特征、治疗和预后,提高临床对该病的认识和重视,做到早预防、早诊断、早治疗,降低新生儿的发病率和死亡率。方法回顾性分析北京市海淀区妇幼保健院2008年1月1日—2013年12月31日分娩的13例感染李斯特菌孕产妇产前、产后和对应新生儿的发病状况、临床表现、实验室指标、病情严重程度、治疗及预后的情况,结合相关文献对围产期孕产妇和新生儿李斯特菌病的临床特点进行探讨。结果 13例李斯特菌感染孕产妇患者均有临床症状,但症状不典型不特异。53.8%患者有高热症状,84.6%诉腹痛,100%引起胎儿宫内窘迫,白细胞总数（12.1×109～26.9×109/L）、中性粒细胞比率（0.650～0.898）和C反应蛋白（10.00～103.00 mg/L）都有不同程度升高;对应13例感染新生患儿均为早发感染,新生儿血流感染8例、新生儿肺炎4例、新生儿颅内出血4例、化脓性脑膜炎3例、新生儿感染性胃肠炎2例,新生儿死亡2例;感染的新生儿白细胞总数（4.7×109～27.6×109/L）、中性粒细胞比率（0.505～0.819）、血小板（79×109～280×109/L）和C反应蛋白（7.00～120.80 mg/L）,单核细胞比率（0.042～0.116）,白细胞总数大部分正常,少部分降低或升高,C反应蛋白和单核细胞比率多数升高,血小板部分降低。孕产妇患者预后良好,新生患儿多预后不良,有2例新生儿死亡。结论产单核细胞李斯特菌极易感染细胞免疫相对低下的孕产妇,通过母婴垂直传播感染新生儿,对新生儿造成严重的不良后果。早预防、早诊断、早治疗可有效降低新生儿发病率和病死率。最为重要的是在孕早期对孕产妇进行食品安全性宣传教育,减少妊娠期感染,是降低新生儿李斯特菌病的重要预防措施。Objective The purpose of this study was to delineate the occurrence and clinical picture, diagnosis and treatment of maternal and neonatal listeriosis in the perinatal period. Methods A total of 13 cases （8 males and 5 females） of perinatal listeriosis were treated from January 2008 to December 2013. The diagnosis of listeriosis was confirmed by positive blood culture, placenta swab culture, uterine cavity swab culture and cerebrospinal fluid culture. Maternal history, perinatal events, clinical features, laboratory findings, treatment and prognosis were retrospectively reviewed. Results All the pregnant women in the 13 reported cases had atypical and nonspecific clinical symptoms, including high fever （7/13）, abdominal pain （11/13）, abnormal fetal movements （10/13）, and premature rupture of membrane （1/13）. All the neonates in the reported 13 cases had symptoms within 48 hours after birth, including preterm infants, dyspnea （7/13）, fever （3/13）, septicemia （8/13）, pneumonia （4/13）, purulent meningitis （3/13）, and death （2/13）. Laboratory findings showed white blood cell count increased （2/13）, and decreased （2/13） and within normal range （9/13）. All the neonates had elevated C-reactive protein. Treatment with ampicillin or penicillin for 1-2 weeks was effective for neonatal listeriosis, but cephalosporins were not effective. Conclusions Our findings suggest that listeriosis may emerge as an important health threat for newborn infants. Neonatal listeriosis is a serious clinical condition with high mortality. Early differential diagnosis and detection of causative organisms, especially in newborn infants infected with Listeria monocytogenes. Use of appropriate antibiotics can decrease maternal mortality and improve neonatal outcome.

关 键 词：产单核细胞李斯特菌 李斯特菌病 孕产妇 新生儿 感染 

分 类 号：R714.7[医药卫生—妇产科学]