35例妊娠期结核性胸膜炎患者临床诊疗结果分析

Clinical analysis of 35 pregnant tuberculous pleurisy patients

目的探讨妊娠期结核性胸膜炎患者的临床特点。方法回顾性分析解放军总医院第八医学中心全军结核病研究所2011年3月至2018年12月收治的35例妊娠期结核性胸膜炎患者的临床资料。患者年龄20~41岁,平均年龄(27.60±5.45)岁。早期妊娠6例(17.1%),中期妊娠16例(45.7%),晚期妊娠12例(34.3%),产褥期1例(2.9%)。结果35例患者中,13例经超声引导下胸膜活检组织病理学检查结果符合结核病而确诊,22例根据结核性胸膜炎临床诊断标准确定诊断。35例患者发热占82.9%(29/35),呼吸困难、咳嗽分别占77.1%(27/35)和57.1%(20/35)。早期人工流产5例,自然流产1例,中期引产13例,继续妊娠至分娩15例,包括3例中期妊娠及全部12例晚期妊娠者,产褥期发病1例。35例患者诊断明确后均给予抗结核药品治疗,经治疗临床症状及胸腔积液消失,无死亡患者;随诊6~55个月,未发现复发患者。16名新生儿中有1名早产儿为低出生体质量,余15名均为足月健康新生儿,未发现新生儿先天畸形。对新生儿随访7~55个月,未发现生长发育异常,也未患结核病。结论妊娠期结核性胸膜炎以临床诊断为主,进行积极的抗结核药品治疗效果明显,并且未对胎儿产生不良影响。

Objective To investigate the clinical characteristics of pregnant tuberculous pleurisy patients.Methods We analyzed the retrospective clinical data from 35 cases with pregnancy complicated with tuberculous pleurisy admitted in the Tuberculosis Research Institute of the 8 th Medical Center of Chinese PLA General Hospital during March 2011 to December 2018.Patients were 20-41 years old,average age was 27.60±5.45 years.6 cases(17.1%)were during their early pregnancy,16 cases(45.7%)in mid-pregnancy,12 cases(34.3%)in late pregnancy and 1 case(2.9%)in puerperium.Results Of 35 patients,13 definite cases were confirmed by histopathological examination with samples collected with ultrasound-guided pleural biopsy,22 cases were clinically diagnosed according to the clinical diagnostic criteria of tuberculous pleurisy.Fever occurred in 82.9%(29/35)of cases,dyspnea and cough accounted for 77.1%(27/35)and 57.1%(20/35)respectively.Among them,5 cases suffered early artificial abortion,1 case got spontaneous abortion,13 cases got induction of labor in mid-pregnancy,15 cases continued pregnancy until delivery(3 cases in mid-pregnancy and all 12 cases in late pregnancy),1 case occurred in puerous period.All patients were treated with anti-tuberculosis drugs after the diagnosis was confirmed,then their clinical symptoms disappeared and pleural effusion were absorbed with no deaths.Patients were followed up for 6 to 55 months and no relapse cases were detected.One of the 16 newborns was premature with low birth weight,the other 15 were healthy term infants,no birth defects were found.The newborns were followed up for 7 to 55 months,no abnormality of growth or development,or tuberculosis were observed.Conclusion Pregnant tuberculous pleurisy patients are mainly diagnosed clinically.The anti-tuberculosis treatment is effective and no adverse effects on fetuses are found.