妊娠合并肾综合征出血热患者临床特征的多中心研究

Clinical characteristics of patients with hemorrhagic fever with renal syndrome during pregnancy:a multicenter clinical study

目的探讨妊娠合并肾综合征出血热(hemorrhagic fever with renal syndrome,HFRS)患者的临床特点及预后。方法纳入2009年11月至2019年2月西安交通大学第二附属医院(4例)、空军军医大学第二附属医院(4例)、西安交通大学第一附属医院(1例)和咸阳市中心医院(2例)收治的11例妊娠合并HFRS患者作为病例组,将同期收治年龄匹配的24例非妊娠女性HFRS患者作为对照组。回顾性分析两组患者的年龄、合并症、临床分型、实验室指标等临床资料,并随访病例组孕妇及其胎儿的临床结局。统计学比较采用曼-惠特尼U检验和χ^(2)检验。结果11例病例组患者年龄为29(22,33)岁,其中7例为重型和危重型;24例对照组患者年龄为32(24,37)岁,其中4例(16.7%)为重型和危重型;两组患者的临床分型差异有统计学意义(χ^(2)=7.722,P=0.015)。病例组中,有10例出现高血容量综合征,10例出现肺水肿,6例出现多期重叠,均高于对照组[2例(8.3%)、2例(8.3%)和2例(8.3%)],差异均有统计学意义(χ^(2)=22.828、22.828、9.135,均P<0.01)。与对照组比较,病例组患者住院期间尿素氮最高值和血清肌酐最高值均较高,差异均有统计学意义(Z=-2.453、-2.336,均P<0.05);血清白蛋白最低值、血红蛋白最高值和最低值均较低,差异均有统计学意义(Z=-3.742、-3.350、-4.034,均P<0.01)。所有妊娠合并HFRS患者治疗后均痊愈,9例患者治愈后足月分娩9名健康婴儿,婴儿出生时均未发现畸形,均接受母乳喂养,喂养时间为6~20个月,平均随访3年均未发现生长发育异常。结论妊娠合并HFRS的患者病程中易出现多期重叠,合并高血容量综合征和急性肺水肿的风险高。患者治愈后可继续妊娠至足月分娩。

Objective To analyze the clinical characteristics and prognosis of pregnant women with hemorrhagic fever with renal syndrome(HFRS).Methods A total of 11 pregnant women with HFRS admitted to The Second Affiliated Hospital of Xi′an Jiaotong University(four cases),The Second Affiliated Hospital of Air Force Medical University(four cases),The First Affiliated Hospital of Xi′an Jiaotong University(one case)and Central Hospital of Xianyang City(two cases)between November 2009 and February 2019 were included as the study group,and 24 age-matched non-pregnant women with HFRS were selected as the control group.The age,complications,clinical classification and laboratory indexes of the two groups were analyzed retrospectively,and the clinical outcomes of pregnant women and their fetuses in the study group were followed up.The data between two groups were compared using Mann-Whitney U test or chi-square test.Results Patients in the study and control groups were 29(22,33)and 32(24,37)years old,respectively.Seven of 11 patients in study group were severe and critical cases,which was significantly higher than that in the control group(16.7%(4/24),χ^(2)=7.722,P=0.015).In the study group,10 patients had hypervolemic syndrome,10 patients had pulmonary edema and six patients had overlapping hypotension shock phase and oliguria phase,which were all higher than those in the control group((2/24,8.3%),(2/24,8.3%)and(2/24,8.3%),respectively;χ^(2)=22.828,22.828 and 9.135,respectively,all P<0.01).Compared with the control group,the pregnant patients in study group had a higher urea nitrogen maximum and serum creatinine maximum,and the differences were both statistically significant(Z=-2.453 and-2.336,respectively,both P<0.05),while they had a lower serum albumin minimum,hemoglobin maximum and hemoglobin minimum,and the differences were all statistically significant(Z=-3.742,-3.350 and-4.034,respectively,all P<0.01).All pregnant women with HFRS recovered.Nine pregnant women gave birth to nine healthy infants.All of them received breastfeeding and the feeding duration were more than six months.No abnormal growth and development were found during an average follow-up of three years.Conclusions Pregnancy can aggravate the severity of HFRS,and pregnant women have higher risk of the multiple stages overlap and the complications such as hypervolemic syndrome and acute pulmonary edema.After recovery from HFRS,mother may carry to full-term pregnancy.