体外受精-胚胎移植患者并发血行播散性肺结核八例临床分析  

The clinical feature of acute hemo-disseminated pulmonary tuberculosis in 8 pregnancy patients of in vitro fertilization-embryo transfer cycle

作　　者：裴宁[1] 卢水华[1] 熊延青[1] 宋瑞娟[1] 

机构地区：[1]上海市公共卫生临床中心结核科,201508

出　　处：《中国防痨杂志》2016年第10期891-894,共4页Chinese Journal of Antituberculosis

摘　　要：对2014年1月1日至2015年12月31日在上海市公共卫生临床中心结核科住院并确诊为血行播散性肺结核的8例体外受精-胚胎移植（in vitro fertilization-embryo transfer，IVF-ET）术后妊娠患者的临床资料进行回顾性分析，并总结其临床特点。患者临床表现：8例乏力、发热（38．5-39．6℃），4例咳嗽、咯痰，3例头痛、呕吐，7例盗汗，5例体质量减轻；3例并发结核性脑膜炎；7例在治疗过程中引产；1例单纯血行播散性肺结核患者足月顺产1名健康男婴。实验室检查：7例涂阳培阳，1例涂阴培阴；8例γ干扰素释放试验检测阳性；3例头痛、呕吐者脑脊液检查均异常。8例行胸部x线摄影、7例行胸部CT检查，均显示异常；3例行头颅MRI检查，发现异常者2例。平均确诊时间为26．5d。说明行IVF-ET术后妊娠并发血行播散性肺结核患者一旦发病，往往病情严重、复杂，就诊于综合医院多延误诊治，加重患者病情，预后欠佳。相关检查结果提示结核病早期临床诊断准确性高，当行IVFET术后妊娠患者出现发热、头痛，且抗炎效果欠佳时，应当及时进行结核病的相关检查，必要时给予预防性抗结核药物治疗。Clinical dates of 8 cases of acute hemo-disseminated pulmonary tuberculosis in vitro fertilization- embryo transfer （IVF-ET） pregnancy patients from January 1. 2014 to December 31. 2015 in Shanghai Public Health Clinical Center were investigated and analyzed. The clinical manifestations： 8 cases with fatigue and fever （38. 5-39.6 ℃）, 4 cases with cough and expectoration, 3 cases with headache and vomiting, 7 cases with night sweat and 5 cases with loss of weight, 3 cases complicated with tuberculosis meningitis. Seven cases were induced during their treatment, one case with acute hemo-disseminated pulmonary tuberculosis had delivered a healthy baby. The laboratory examinations： sputum smear and culture were positive in 7 cases, sputum smear and culture were negative in one case. The interferon-y release assays （IGRAs） of 8 cases were all positive. The cerebrospinal fluid tests of 3 cases with headache and vomiting were abnormal. The chest X-rays of 8 cases and chest CT of 7 cases were abnormal. Three cases were given head MRI examinations and 2 cases were abnormal. The average time of diagnosis

关 键 词：受精 体外 胚胎移植 结核 肺/妊娠期 血行播散 

分 类 号：R529.9[医药卫生—内科学]