妊娠相关李斯特菌病6例临床分析  

Clinical analysis of 6 cases of pregnancy-associated listeriosis

作　　者：林琳[1] 江庆萍[2] 杨中凤 周燕媚 印贤琴 陈娟娟[1] 任露雯 杜丽丽[3] 陈兢思[4] 苏春宏[1] 陈敦金[1] LIN Lin;JIANG Qing-ping;YANG Zhong-feng;ZHOU Yan-mei;YIN Xian-qin;CHEN Juan-juan;REN Lu-wen;DU Li-li;CHEN Jing-si;SU Chun-hong;CHEN Dun-jin(Department of Obstetrics and Gynecology of the Third Affiliated Hospital of Guangzhou Medical University,Guangdong Provincial Key Laboratory of Major Obstetric Diseases,Guangdong-Hong Kong-Macao Greater Bay Area Higher Education Joint Laboratory of Maternal-Fetal Medicine,Guangdong Engineering and Technology Research Center of Maternal-Fetal Medicine,Guangzhou 510150 China;不详)

机构地区：[1]广州医科大学附属第三医院广东省产科重大疾病重点实验室粤港澳母胎医学高校联合实验室广东省母胎医学工程技术研究中心妇产科,广东广州510150 [2]广州医科大学附属第三医院广东省产科重大疾病重点实验室粤港澳母胎医学高校联合实验室广东省母胎医学工程技术研究中心病理科,广东广州510150 [3]广州医科大学附属第三医院广东省产科重大疾病重点实验室粤港澳母胎医学高校联合实验室广东省母胎医学工程技术研究中心妇研所实验部,广东广州510150 [4]广州医科大学附属第三医院广东省产科重大疾病重点实验室粤港澳母胎医学高校联合实验室广东省母胎医学工程技术研究中心产前诊断科,广东广州510150

出　　处：《中国实用妇科与产科杂志》2022年第7期743-747,共5页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家重点研发计划(2018YFC1002900);国家自然科学基金重点项目(81830045,82071652);广东省自然科学基金面上项目(2020A1515010273)。

摘　　要：目的探讨妊娠相关李斯特菌病的发生率、临床特征、母儿结局、治疗及预防。方法回顾性分析自2014年1月1月至2020年12月31日在广州医科大学附属第三医院收治的妊娠相关李斯特菌病患者共6例,包括一般临床特征、临床表现、发病孕周、发病季节、实验室检查、抗生素使用情况、妊娠结局。结果妊娠相关李斯特菌病的发生率为10.29/10万。孕妇年龄29~37岁,3例妊娠中期确诊,3例妊娠晚期确诊,3例有妊娠期合并症。首发症状为发热的有5例,1例为胎动减少,3例出现腹痛或阴道流血症状,1例出现尿痛症状,2例出现头痛、咳嗽的流感样症状。6例病例菌株来源:1例脐血和胎膜培养阳性,5例血培养阳性。4例患者外周血白细胞升高,5例胎盘病理检查胎盘实质可见脓肿形成,革兰氏染色呈阳性。3例经初步治疗而后根据药敏调整治疗的过程。3例晚孕孕妇因考虑“胎儿窘迫”行剖宫产术,3例中孕孕妇因病情严重发生难免流产或引产。2例新生儿入住新生儿科,分别住院26 d及59 d痊愈出院。结论妊娠相关李斯特菌病早期无症状或临床症状无特异性,但对胎儿及新生儿影响严重,不良妊娠结局发病率高。早识别、早诊断、早治疗可能改善妊娠结局。Objective To analyze the incidence,clinical features,maternal and infant outcomes,treatment and prevention of pregnancy-associated listeriosis.Methods A retrospective analysis was performed on 6 pregnancyassociated listeriosis who were admitted to the Third Hospital Affiliated to Guangzhou Medical Univesity from January 1,2014 to December 31,2020.The clinical characteristic,clinical manifestations,gestational age at onset,onset season,laboratory examination,antibiotic treatment,and the pregnancy outcome were analyzed.Results The incidence of pregnancy-associated Listeriosis was 10.29/100000.The pregnant women were 29-37 years old,3 cases were diagnosed in the second trimester and 3 cases were diagnosed in the third trimester.Three patients had complications during pregnancy.The first symptoms were fever in 5 cases,decreased fetal movement in 1 case,abdominal pain or vaginal bleeding in 3 cases,urinalgia in 1 case,and flu-like symptoms such as headache and cough in 2 cases.Strains of 6 cases were obtained from umbilical cord blood and fetal membrane culture in 1 case and blood culture in 5 cases.Peripheral leukocytes were elevated in 4 patients.Placental pathology showed abscess formation in placental parenchyma in 5 cases and positive gram staining.The course of treatment was adjusted according to drug sensitivity after initial treatment in 3 cases.Three cases in the third trimester underwent cesarean section due to"fetal distress",and 3 cases in the second trimester underwent inevitable abortion or induced labor due to serious condition.Two neonates were admitted to the neonatology department and were discharged from hospital after 26 days and 59 days respectively.Conclusion Pregnancy-associated listeriosis is asymptomatic in early stage or there is no specific clinical symptoms,but it has a serious impact on fetuses and neonates,and the incidence of adverse pregnancy outcomes is high.Early identification,early diagnosis and early treatment may improve pregnancy outcome.

关 键 词：妊娠 李斯特菌病 食源性疾病 妊娠结局 

分 类 号：R714.2[医药卫生—妇产科学]