23例妊娠并发结核病患者的临床分析  

Clinical Analysis in 23 Pregnant Cases Complicated with Tuberculosis

作　　者：刘荣梅[1] 马丽萍[1] 孔忠顺[1] 黄麦玲[1] 陈红梅[1] 宋艳华[1] 高孟秋[1] 

机构地区：[1]首都医科大学附属北京胸科医院结核二科,101149

出　　处：《结核病与胸部肿瘤》2017年第1期46-50,共5页Tuberculosis and Thoracic Tumor

摘　　要：目的探讨妊娠并发结核病患者的临床特点。方法回顾性分析首都医科大学附属北京胸科医院2012年5月至2015年8月收治的23例妊娠并发结核病患者的临床资料，包括一般资料、临床症状及体征，胸部CT、头颅MRI等影像学资料，痰标本染色镜检、液体培养及血γ-干扰素释放试验等检测结果，经菌种鉴定确定为结核分枝杆菌感染，并归纳总结其临床诊治特点。结果23例妊娠并发结核病患者中，并发肺结核8例、结核性胸膜炎2例、肺结核＋结核性脑膜脑炎或结核性脑膜炎10例、继发性肺结核＋结核性胸膜炎3例。患者临床表现为全身中毒症状突出，发热、纳差分别占78.3％（18／23）和73．9％（17／23）；呼吸道症状以咳嗽为主，占73．9％（17／23）。早期妊娠ll例（47．8％），中期妊娠5例（21．8％），晚期妊娠3例（13．0％），产褥期4例（17．4％）；其中，先患结核病后发现妊娠者6例（26．1％），妊娠后发现罹患结核病者17例（73．9％）。23例妊娠并发结核病患者3例试管婴儿均自然流产，12例行人工流产术，3例发生新生儿死亡，5例分娩健康婴儿。23例患者诊断明确后均给予合理的联合抗结核药物治疗，20例患者经抗结核药物治疗好转，3例重症结核病患者死亡。结论妊娠并发结核病患者临床全身中毒症状重，多并发中枢系统结核而危及生命。早中期妊娠患者及时终止妊娠是必须面对的选择；对晚期妊娠患者进行积极治疗，转归较理想。Objective To investigate the clinical characteristics in pregnant patients complicated with tuberculosis. Methods We analyzed retrospectively the clinical data from 23 cases with pregnancy complicated with tuberculosis admitted in Beijing Chest Hospital, Capital Medical University and infected by Mycobacterium tuberculosis during May 2012 to Aug 2015 including general data, clinical symptom and sign, chest CT, brain MRI, sputum smear, liquid culture and interferon gamma release assay （IGRA） and summed up clinical characteristics of diagnosis and treatment. Results Of 23 patients, there were complicated by pulmonary tuberculosis in 8 cases, tuberculous pleurisy in 2 cases, tuberculous meningitis complicated by pulmonary tuberculosis or not in 10 cases, tuberculous pleurisy complicated by pulmonary tuberculosis in 3 cases. The clinical manifestations in all patients with systemic poisoning symptoms were obvious. Fever and anorexia accounted for 78.3% （18/23） and 73.9% （17/23）, respectively. Respiratory symptom with cough was up to 73.9% （17/23）. There were early pregnancy in 11 cases （47.8%）, mid-pregnancy in 5 cases （21.8%）, late pregnancy in 3 cases （13.0%）, puerperium in 4 cases （17.4%）. among them, Pregnancy was pre-existed tuberculosis in 6 cases （26.1%） and was post-existed tuberculosis in the other cases （73.9%）. There were spontaneous abortion in 3 cases with artificial reproduction, artificial abortion in 12 cases, neonatal death in 3 cases and delivery healthy baby in 5 cases. All patients were treated with reasonable antituberculosis regimen and improvement in 20 cases, death due to severe tuberculosis in 3 cases. Conclusion Pregnant patients complicated with tuberculosis have clinical systemic poisoning symptoms and is life-threatening when complicated with central nervous system tuberculosis. Early to mid-pregnant patients need to timely terminate pregnancy. Late pregnancy patients complicated with tuberculosis have ideal outcomes when treated actively with antit

关 键 词：妊娠并发症 感染性 结核 治疗结果 数据说明 统计 结果与过程评价(卫生保健) 

分 类 号：R181.3[医药卫生—流行病学]