妊娠合并结核64例临床分析

Clinical analysis of 64 cases pregnancy complicated with tuberculosis

目的 探讨分析妊娠合并结核延迟就诊和及时就诊孕妇的临床特征、转归及围产结局差异,为改善结核孕妇预后提供经验思路。方法 回顾性统计分析2017年1月—2022年1月就诊于解放军总医院第八医学中心结核病研究所的妊娠合并结核孕妇的病历资料,分为延迟就诊组和及时就诊组,分析两组孕妇临床症状、结核转归及围产结局。结果 延迟就诊组中,以意识障碍就诊的患者7例(16.2%)显著多于及时就诊组1例(5.5%),差异有统计学意义(P<0.05),而以头痛、胸闷憋气、咳嗽咳痰及体重减轻症状就诊则无明显统计学差异(P>0.05);延迟就诊组和及时就诊组中转归为血行播散型肺结核/结核性脑膜炎的患者分别为38例(82.6%)和5例(27.7%)、重症(神经系统后遗症、昏迷)27例(58.6%)和3例(16.6%)、死亡3例(6.5%)和0例(0.0%)、病情平稳6例(13.0%)和10例(55.5%),均有统计学差异(P<0.05)。围产结局中,延迟就诊组和及时就诊组在年龄、孕前体重、终止妊娠方式、结核类型、新生儿体重、活产率均无明显统计学差异(P>0.05);延迟就诊组的诊断孕周(22.2±6.5比15.4±7.3)、终止妊娠孕周(28.6±9.3比23.7±14.6)较及时就诊组偏大,差异有统计学意义(P<0.05)。结论 妊娠合并结核容易发生延误诊治;有必要加强孕妇结核宣教、提高医生对妊娠合并结核警觉性,做到早就诊、早诊断、早治疗,有助于改善孕妇结核预后及围产结局。

Objective To explore and analyze the differences in clinical features,outcomes and perinatal outcomes between delayed and timely treatment of pregnant women with tuberculosis,so as to provide empirical ideas for improving the prognosis of pregnant women with tuberculosis.Methods The medical records of pregnant women with tuberculosis admitted to the Tuberculosis Institute of the Eighth Medical Center of the PLA General Hospital from January 2017 to January 2022 were retrospectively analyzed.They were divided into the delayed treatment group and the timely treatment group.The clinical symptoms,tuberculosis outcomes and perinatal outcomes of the two groups were analyzed.Results In the delayed treatment group,7 patients(16.2%)with consciousness disorder were significantly more than 1 patient(5.5%)in the timely treatment group,the difference was statistically significant(P<0.05),but there was no statistically significant difference in the symptoms of headache,chest tightness and choking,cough and sputum and weight loss(P>0.05).In the delayed and timely treatment groups,38 cases(82.6%)and 5 cases(27.7%)of patients with hematogenous disseminated tuberculosis/tuberculous meningitis,27 cases(58.6%)and 3 cases(16.6%)of patients with severe disease(neurological sequelae,coma),3 cases(6.5%)and 0 cases(0.0%)of patients died,and 6 cases(13)of patients with stable disease.0%)and 10 cases(55.5%),there were statistical differences in the above indexes between the two groups(P<0.05).In perinatal outcomes,there were no significant differences in age,pre-pregnancy weight,method of termination of pregnancy,tuberculosis type,neonatal weight and live birth rate between the delayed and timely treatment groups(P>0.05).The weeks of diagnosis(22.2±6.5 vs 15.4±7.3)and termination of pregnancy(28.6±9.3 vs 23.7±14.6)in the delayed treatment group were larger than those in the timely treatment group,the difference was statistically significant(P<0.05).Conclusion Pregnancy with tuberculosis is prone to delay diagnosis and treatment;It is necessary to strengthen the education and awareness of pregnant women with tuberculosis and improve doctors′awareness of pregnancy complicated with tuberculosis.Early treatment,diagnosis and treatment are helpful to improve the prognosis and perinatal outcome of pregnant women with tuberculosis.