9例患者体外受精-胚胎移植术后妊娠合并结核临床结局报告并文献复习  

Clinical pregnancy outcome of 9 patients complicated with tuberculosis after IVF-ET and literature review

作　　者：陈颖 褚轶凡 张博 岳静[1] CHEN Ying;CHU Yi-fan;ZHANG Bo;YUE Jing(Reproductive Medicine Center,Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430030)

机构地区：[1]华中科技大学同济医学院附属同济医院生殖医学中心,武汉430030

出　　处：《生殖医学杂志》2022年第7期891-898,共8页Journal of Reproductive Medicine

基　　金：湖北省科技厅面上项目(2021CFB361)。

摘　　要：目的探究体外受精-胚胎移植术(IVF-ET)后妊娠合并活动性结核患者的临床表现与结局。方法分析本中心2011年以来的9例IVF后妊娠合并活动性结核的临床病例;查阅国内外相关文献,对20篇文献中151例IVF后妊娠合并活动性结核患者的临床资料进行总结。结果(1)9例患者均有不同程度的发热,伴或不伴阴道出血,胸部X线检查确诊为肺结核,其中1例患者并发子宫内膜结核、1例患者并发颅内感染;3例患者自然流产,余6例人工终止妊娠。(2)总结文献报道的151例IVF后妊娠活动性结核患者中,肺结核(80.1%,121/151)最常见,结核性脑膜炎(31.1%,47/151)次之;94.0%(142/151)患者的首发症状为发热。患者确诊用时普遍较长;151名孕妇中仅19例成功分娩(12.6%,19/151),8例早产中有4例先天性结核,11例足月产中有3例先天性结核。抗结核治疗后4名孕妇遗留神经系统后遗症、1例昏迷,6例死亡,死亡率为4.0%。结论建议拟行IVF的女性在促排卵前接受结核筛查。妊娠后如出现不明原因发热、阴道出血等症状且对常规抗感染治疗效果不佳者要考虑妊娠合并活动性结核的可能,早诊断早治疗可能对改善临床结局有一定益处。Objective:To investigate the clinical manifestations and pregnancy outcome in the patients complicated with active tuberculosis after IVF-ET.Methods:The clinical data of 9 patients complicated with active tuberculosis after IVF-ET were analyzed,and the relevant literatures at home and abroad were reviewed.Meanwhile,the clinical data of 20 literatures including 151 patients who got pregnancy and complicated with active tuberculosis after IVF-ET were summarized and reviewed.Results:(1)All nine patients had different degrees of fever with or without vaginal bleeding.Pulmonary tuberculosis was diagnosed by chest X-ray.In addition,one patient was diagnosed endometrial tuberculosis,one patient suffered from intracranial infection concurrently.Three patients were spontaneous abortion,and 6 patients underwent induced abortion.(2)According to the published literatures,miliary tuberculosis(80.1%,121/151)was the most common in 151 pregnancy patients after IVF-ET,and tuberculous meningitis(31.1%,47/151)was the next.The patients committed in hospital induced by fever accounted for 94.0%(142/151)of all the patients.Delayed diagnosis was noted in most pregnancy women with tuberculosis.Only 19 of the 151 pregnant women delivered(12.6%,19/151).including 8 premature births and 4 of whom suffered from congenital tuberculosis,11 full-term births and 3 of whom suffered from congenital tuberculosis.After anti-tuberculosis treatment,4 pregnant women had neurological sequelae,1 patient was in a coma,6 patients died,and the mortality rate was 4.0%.Conclusions:It is recommended that women who intend to undergo IVF receive tuberculosis screening before ovulation induction.In case of unexplained fever,vaginal bleeding and other symptoms after pregnancy and poor effect of routine anti-infection treatment,the possibility of pregnancy complicated with active tuberculosis should be considered.Early diagnosis and early treatment may be beneficial to improve the clinical outcome.

关 键 词：体外受精-胚胎移植 粟粒性结核 妊娠 

分 类 号：R715.2[医药卫生—妇产科学]