体外受精-胚胎移植受孕与自然受孕患者合并结核病的临床特点分析

Clinical analysis of tuberculosis complicated by IVF-ET and natural fertilization

目的探讨体外受精-胚胎移植(in-vitro fertilization and embryo transfer,IVF-ET)受孕与自然受孕患者合并结核病的临床特点及预后。方法回顾性分析陕西省西安市胸科医院2012年12月1日至2019年4月1日收治的65例妊娠合并结核病患者的临床资料,按照受孕方式分为IVF-ET受孕合并结核病患者(IVF-ET组)12例,自然受孕合并结核病患者(自然受孕组)53例,对两组患者临床症状、结核病类型、影像学特点、实验室检查、药物性肝损伤情况及治疗结局进行对比分析。结果 IVF-ET组CD4^+T淋巴细胞数低于自然受孕组,发热程度以及血行播散性肺结核、药物性肝损伤、胎儿不良结局方面均高于自然受孕组,差异有显著性(P<0.05)。结论 IVF-ET受孕合并结核病患者较自然受孕合并结核病患者,肺部病灶范围更广,全身中毒症状更突出,重症结核占比大,细胞免疫水平更低,更易发生抗结核药物性肝损伤,胎儿(胚胎)结局不良。

Objective To investigate the clinical characteristics and prognosis of tuberculosis in vitro fertilization and embryo transfer(IVF-ET)and natural pregnancy. Method Retrospective analysis was used to collect the clinical data of pregnant women with tuberculosis admitted to Xi’an Chest Hospital from December 1, 2012 to April 1, 2019. They were divided into 12 cases of IVF-ET with tuberculosis and 53 cases of natural pregnancy with tuberculosis. Result The number of CD4^+ T lymphocyte in IVF-ET group was lower than that in natural pregnancy group. The incidence of fever, hematogenous disseminated pulmonary tuberculosis, drug-induced liver injury and fetal adverse outcomes in IVF-ET group were higher than those in natural pregnancy group(P<0.05). Conclusion Compared with natural pregnancy with tuberculosis, IVF-ET patients with tuberculosis have broader lung lesions, more prominent symptoms of systemic poisoning, larger proportion of severe tuberculosis, more prone to anti-tuberculosis drugs induced liver injury and poor fetal(embryonic) outcomes than those with natural pregnancy and tuberculosis.