妊娠合并登革热的临床特点及妊娠结局

Clinical characteristics and outcomes of dengue virus infection during pregnancy

目的探究妊娠合并登革热患者的临床表现特点及妊娠结局。方法回顾调查2014年1月1日至2014年12月31日广东省妇幼保健院接诊的妊娠合并登革热患者的临床表现、妊娠结局以及新生儿的临床资料。结果63例妊娠合并登革热患者的主要临床表现为发热（100.0%）、全身酸痛（42.9%）、头痛（41.3%）、皮疹（41.3%）、乏力（34.9%）、肌肉痛或关节痛（17.5%）、恶心呕吐（12.7%）等；所有患者中白细胞、血小板和中性粒细胞计数减少比例分别为17.5%、20.6%和6.3%，且发病5～6 d降低至最低点。63例孕妇中3例流产（4.8%，孕早期）、1例胎死宫内（1.6%，孕22周）和2例人工流产；48名孕妇分娩，剖宫产率为37.5%，早产率为12.5%，低出生体质量率为8.2%，2名新生儿经母婴垂直传播感染登革病毒，母亲-新生儿的登革病毒核酸序列同源性均〉99.9%。结论妊娠合并登革热患者临床表现无特异性，临床应结合流行病学史及早诊断。孕期感染登革病毒可能与流产、胎死宫内、早产等不良妊娠结局有一定关联，围生期感染可造成新生儿母婴垂直传播感染。

ObjectiveTo describe the clinical characteristics and outcomes of dengue virus infection during pregnancy.MethodsA retrospective study was performed based on the clinical data of manifestations, pregnancy outcomes and neonates in patients with dengue virus infection during pregnancy from January 1st, 2014 to December 31th, 2014 at maternity ward in Guangzhou.ResultsThe most common manifestations in patients with dengue virus infection during pregnancy were fever （100.0%）, body soreness （42.9%）, headache （41.3%）, cutaneous rash （41.3%）, fatigue （34.9%） and muscle pain or arthralgia （17.5%）, nausea and vomiting （12.7%）. The decline proportions of leukocyte, platelet and neutrophil count were 17.5%, 20.6% and 6.3%, respectively, and the lowest point was observed on 5—6 days after the onset of illness. Miscarriage was observed in 3 pregnant patients （4.8%, all in the first trimester）, intra-uterine death in one patient （1.6%, at 22 weeks of gestation） and artificial abortion in 2 cases. A total of 48 patients delivered, among whom caesarean section rate was 37.5%, prematurity rate was 12.5% and low birth weight rate was 8.2%. Maternal–foetal vertical transmission happened in 2 cases. Sequence alignment demonstrated that the homologies of the nucleic acids and amino acids within each dengue virus vertical transmission mother-infant pairs were 〉99.9%.ConclusionsThe manifestations of dengue virus infected women with pregnancy are not specific. Early detection and early diagnosis should be made according to the history of epidemiology for women with reproductive age in endemic areas. Maternal dengue virus infection during pregnancy might cause vertical transmission and is correlated with bad outcomes of pregnancy, including miscarriage, intra-uterine death and premature birth. Perinatal infection might cause maternal-foetal vertical transmission.