妊娠合并肾移植术后的妊娠结局分析  

Obstetric Outcomes in Kidney Transplant Recipients

作　　者：祝彩霞[1] 王马列[1] 杨娟[1] 袁林静 牛刚[1] ZHU Cai-xia;WANG Ma-lie;YANG Juan;YUAN Lin-jing;NIU Gang(Department of Obstetrics and Gynecology,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院妇产科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2021年第6期900-905,共6页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81702550)。

摘　　要：【目的】探讨妊娠合并肾移植术后的患者的妊娠结局。【方法】回顾性分析2015年1月至2021年5月在中山大学附属第一医院住院分娩的12例妊娠合并肾移植术后的患者的临床资料,并随访妊娠结局。【结果】12例肾移植术后患者中,3例足月分娩,9例未足月分娩。患者平均分娩年龄(32.3±4.5)岁,距离肾移植平均时间为(63.3±34.7)月,平均分娩孕周为(34.8±2.3)周。所有患者孕期的免疫抑制方案为他克莫司+泼尼松+硫唑嘌呤,孕期监测他克莫司血药浓度均在有效范围,其中6例患者孕早期吗替麦考酚酯更换为硫唑嘌呤。12例患者中7例妊娠晚期并发子痫前期,妊娠期糖尿病3例,中度贫血4例,轻度贫血2例,中央性前置胎盘1例。剖宫产11例,阴道分娩1例,均无产后出血和产褥感染,其中2例患者在产后42 d复查肾功能,出现移植肾功能不全,需透析治疗。12例新生儿均为单胎活产,平均出生体质量为(2348±698.8)g,低出生体质量儿7例,转NICU 8例,出生时均无出生缺陷,平均住院天数14 d,均为人工喂养,随访中生长发育指标均达标,未发生免疫系统缺陷。【结论】肾移植术后妊娠是高危妊娠,需在多学科协作诊疗团队密切监护下,制定个体化的精准治疗方案,选择适当的妊娠时机、严密母胎监护,适时终止妊娠,方可改善妊娠合并肾移植术后的患者的妊娠结局。【Objective】To explore the obstetric outcomes of pregnancies in women with kidney transplant.【Methods】A retrospective study was done on 12 kidney transplant recipients who gave birth in the First Affiliated Hospital,Sun Yatsen University between January 2015 and May 2021.The clinical data and obstetric outcomes were analyzed.【Results】Among 12 kidney transplant recipients,3 had full-term births and 9 preterm births.The mean maternal age was(32.3±4.5)years,with a mean period of(63.3±34.7)months after kidney transplantation.The mean gestation at birth was(34.8±2.3)weeks.All the recipients received tacrolimus,predinisone and azathioprine for immunosuppression during pregnancy,with effective range of tacrolimus blood concentration.Of 12 recipients,6 switched from use of mycophenolate mofetil before pregnancy to Azathioprine in the first trimester.There were 7 cases of preeclampsia in the third trimester,3 gestational diabetes mellitus,4 moderate anemia,2 mild anemia and 1 central placenta previa.Eleven cases had cesarean sections and one had vaginal spontaneous delivery.No case suffered postpartum hemorrhage and puerperal infection.Two cases developed renal graft dysfunction requiring hemodialysis 42 days after delivery.All the 12 live births were singleton and the mean birth weight was(2348±698.8)g,with 7 with low birth wight and 8 transferred to neonatal intensive care unit(NICU).All the newborns showed no birth defect and their average length of hospital stay was 14 days.They were artificially fed and no abnormality was found in their physical development,intelligence and immune system during follow-up.【Conclusion】Due to the high risk of pregnancy after kidney transplantation,multidisciplinary collaborative and individualized precise diagnosis and treatment are encouraged.The optimal pregnancy timing,close maternal/fetal monitoring and timely pregnancy termination could improve the obstetric outcomes in kidney transplant recipients.

关 键 词：肾移植 妊娠 围产结局 妊娠并发症 

分 类 号：R699.2[医药卫生—泌尿科学] R714[医药卫生—外科学]