28例体外受精-胚胎移植后妊娠并发结核病患者临床特征及母婴结局

Clinical characteristics and maternal and neonatal outcomes of 28 cases of pregnancies complicated with tuberculosis after in vitro fertilization-embryo transfer

目的:了解体外受精-胚胎移植后妊娠并发结核病患者临床特征及母婴结局。方法:回顾性纳入成都市公共卫生临床医疗中心2012年5月至2024年5月期间收治的体外受精-胚胎移植后妊娠并发结核病患者共计28例的临床资料,对患者的临床特征、母婴结局进行描述性分析。结果:28例患者平均年龄为(31.1±3.6)岁,妊娠时间[中位数(四分位数)]为108.0(84.0,141.0)d,早期妊娠9例(32.1%),中期妊娠19例(67.9%)。28例患者以发热(27例)、咳嗽(24例)、气促(20例)、阴道流血(17例)为主要临床表现。有27例(96.4%)患者为血行播散性肺结核,合并肺外结核15例(53.6%),其中,结核性脑膜炎14例(50.0%),同一例患者同时患≥3种类型结核病者10例(35.7%)。28例患者中结核病病原学阳性者13例(46.4%),耐药患者2例,分别为利福平耐药及准广泛耐药。实验室检查:血红蛋白为(98.6±12.4)g/L,血清白蛋白为(30.7±4.6)g/L,CD4^(+)T淋巴细胞计数为212.5(125.0,319.5)个/μl。28例患者中气管插管有创机械通气3例(10.7%),无创呼吸机13例(46.4%),截至2024年7月治疗成功21例(75.0%),死亡1例,6例尚在治疗过程中,目前均好转。在治疗期间13例(53.8%)患者发生了不良反应,包括7例(25.0%)肝功能损伤、4例(14.3%)骨髓抑制、2例(7.1%)药物性皮疹,1例(3.6%)药物热。28例患者共孕43名胎儿,5例自然流产,其余均人工终止妊娠。结论:体外受精-胚胎移植后妊娠并发结核病患者以发热及呼吸道症状为主,重症结核病发生率高,通过积极有效的抗结核治疗大多预后良好,该类患者应重视产前结核病筛查,产后密切监测,提高诊断准确率。

Objective:To evaluate the clinical characteristics and maternal and neonatal outcomes of pregnancies complicated by tuberculosis following in vitro fertilization-embryo transfer(IVF-ET).Methods:A retrospective analysis was conducted on clinical data from 28 cases of pregnancies complicated by tuberculosis after IVF-ET,admitted to the Public Health Clinical Medical Center between May 2012 and May 2024.The clinical characteristics and maternal and neonatal outcomes were descriptively analyzed.Results:The mean age of the 28 patients was(31.1±3.6)years,with a median gestational period of 108.0 days(interquartile range:84.0-141.0 days).Among these cases,9(32.1%)were in early pregnancy and 19(67.9%)were in the mid-trimester.The primary clinical manifestations included fever(27 cases),cough(24 cases),shortness of breath(20 cases),and vaginal bleeding(17 cases).Hematogenous disseminated pulmonary tuberculosis was observed in 27 patients(96.4%),while 15 patients(53.6%)had extrapulmonary tuberculosis,and 14(50.0%)were diagnosed with tuberculous meningitis.Additionally,10 patients(35.7%)presented with three or more types of tuberculosis simultaneously.Among the 28 patients,13(46.4%)tested positive for tuberculosis etiology,and 2 patients had drug-resistant tuberculosis(rifampicin-resistant and pre-extensively drug-resistant tuberculosis).Laboratory examinations showed a mean hemoglobin level of(98.6±12.4)g/L,a mean serum albumin level of(30.7±4.6)g/L,and a median CD4^(+)T-cell count of 212.5 cells/μl(interquartile range:125.0-319.5 cells/μl).Of the 28 patients,3(10.7%)required tracheal intubation with invasive mechanical ventilation,while 13(46.4%)used non-invasive ventilatory support.By July 2024,21 patients(75.0%)had successfully completed treatment,1 patient had died,and 6 patients were still undergoing treatment,all of whom were showing improvement.Adverse reactions were noted in 13 patients(53.8%)during treatment,including 7 cases(25.0%)of liver function injury,4 cases(14.3%)of bone marrow suppression,2 cases(7.1%)of drug-induced rash,and 1 case(3.6%)of drug fever.A total of 43 fetuses were conceived by the 28 patients,with 5 resulting in spontaneous abortions,and the remainder undergoing elective termination.Conclusion:The majority of pregnant patients with tuberculosis following in vitro IVF-ET present with fever and respiratory symptoms,and the incidence of severe tuberculosis is notably high.Most patients achieve a favorable prognosis with prompt and effective anti-tuberculosis treatment.Emphasis should be placed on prenatal tuberculosis screening and close postpartum monitoring to enhance diagnostic accuracy.