中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2015年
9期
763-767
,共5页
王澎%陈颖茜%王焕玲%杨爽%徐英春%李太生
王澎%陳穎茜%王煥玲%楊爽%徐英春%李太生
왕팽%진영천%왕환령%양상%서영춘%리태생
妊娠%单核李斯特菌%败血症
妊娠%單覈李斯特菌%敗血癥
임신%단핵리사특균%패혈증
Pregnancy%Listeria monocytogenes%Sepsis
目的 通过分析妊娠期李斯特菌病的特点,提高对妊娠期李斯特菌病的认识.方法 回顾性分析北京协和医院2007年3月-2014年12月诊治的16例经实验室明确诊断的妊娠期李斯特菌病临床特点.结果 (1)患者年龄(30.0±3.9)岁,感染发生在妊娠早、中、晚期分别为1例、8例、7例;(2)起病时间的中位数为2.5d,临床表现主要为发热(93.8%,15/16)、血白细胞增高(78.6%,11/14)、胎盘急性胎膜绒毛膜炎(77.8%,7/9)、胃肠道症状(37.5%,6/16)、胎动减少或消失(31.3%,5/16)等;(3)检出李斯特菌的标本分别来源于患者的血液(6例)、宫腔拭子(6例)、血液和宫腔拭子(1例),新生儿(3例);(4)93.8%(15/16)患者出现不良妊娠结局,胎儿死亡8例、新生儿李斯特菌败血症经治疗存活7例;(5)患者在结束妊娠后恢复良好,无孕妇死亡;(6)初始经验性抗菌药物没有覆盖李斯特菌.结论 妊娠期李斯特菌病起病急,以发热为突出表现,妊娠不良结局发生率高,但经验性抗菌药物覆盖率低,提示应提高临床医生对该病的认识并加强孕妇饮食卫生宣教.
目的 通過分析妊娠期李斯特菌病的特點,提高對妊娠期李斯特菌病的認識.方法 迴顧性分析北京協和醫院2007年3月-2014年12月診治的16例經實驗室明確診斷的妊娠期李斯特菌病臨床特點.結果 (1)患者年齡(30.0±3.9)歲,感染髮生在妊娠早、中、晚期分彆為1例、8例、7例;(2)起病時間的中位數為2.5d,臨床錶現主要為髮熱(93.8%,15/16)、血白細胞增高(78.6%,11/14)、胎盤急性胎膜絨毛膜炎(77.8%,7/9)、胃腸道癥狀(37.5%,6/16)、胎動減少或消失(31.3%,5/16)等;(3)檢齣李斯特菌的標本分彆來源于患者的血液(6例)、宮腔拭子(6例)、血液和宮腔拭子(1例),新生兒(3例);(4)93.8%(15/16)患者齣現不良妊娠結跼,胎兒死亡8例、新生兒李斯特菌敗血癥經治療存活7例;(5)患者在結束妊娠後恢複良好,無孕婦死亡;(6)初始經驗性抗菌藥物沒有覆蓋李斯特菌.結論 妊娠期李斯特菌病起病急,以髮熱為突齣錶現,妊娠不良結跼髮生率高,但經驗性抗菌藥物覆蓋率低,提示應提高臨床醫生對該病的認識併加彊孕婦飲食衛生宣教.
목적 통과분석임신기리사특균병적특점,제고대임신기리사특균병적인식.방법 회고성분석북경협화의원2007년3월-2014년12월진치적16례경실험실명학진단적임신기리사특균병림상특점.결과 (1)환자년령(30.0±3.9)세,감염발생재임신조、중、만기분별위1례、8례、7례;(2)기병시간적중위수위2.5d,림상표현주요위발열(93.8%,15/16)、혈백세포증고(78.6%,11/14)、태반급성태막융모막염(77.8%,7/9)、위장도증상(37.5%,6/16)、태동감소혹소실(31.3%,5/16)등;(3)검출리사특균적표본분별래원우환자적혈액(6례)、궁강식자(6례)、혈액화궁강식자(1례),신생인(3례);(4)93.8%(15/16)환자출현불량임신결국,태인사망8례、신생인리사특균패혈증경치료존활7례;(5)환자재결속임신후회복량호,무잉부사망;(6)초시경험성항균약물몰유복개리사특균.결론 임신기리사특균병기병급,이발열위돌출표현,임신불량결국발생솔고,단경험성항균약물복개솔저,제시응제고림상의생대해병적인식병가강잉부음식위생선교.
Objective To summarize the clinical characteristics and outcome of maternal listeriosis so as to improve the understanding of disease and the level of diagnosis and treatment.Methods Retrospectively,16 cases of maternal listeriosis,who were treated at Peking Union Medical College Hospital between March 2007 and December 2014 were reviewed.Maternal listeriosis is defined when a pregnant woman presents with symptoms as listeriosis,meanwhile Listeria monocytogenes is isolated from sterile tissue or peripheral blood,or from a non-sterile site (uterus swab) or pathological evidence of chorioamnionitis.The neonatal listeriosis is diagnosed as acute listeria sepsis.Results The mean age of these 16 patients was (30.0 ± 3.9) years old.There were 1,8,7 patients with listeriosis diagnosed in the first,second and third trimester of pregnancy,respectively.All had an acute onset of illness (≤2 weeks),the median time from onset to presentation was 2.5 days.Clinical manifestations included fever (93.8%,15/16),leukocytosis (78.6%,11/14),chorioamnionitis (77.8%,7/9),gastrointestinal symptoms (37.5%,6/16) and fetal movement decrease (31.3%,5/16).Listeria monoeytogenes were isolated from blood (6 cases),uterus swab (6 cases),blood plus uterus swab (1 case),and neonates (3 cases).All maternal cases recovered well after the termination of pregnancy,even none of them had received empiric antibiotics sensitive to listeria.A very high proportion of adverse pregnancy outcomes occurred (15/16,93.8%).There were 8 fetal losses.Seven neonates were complicated with listeria sepsis and treated successfully.Conclusions The patients with maternal listeriosis commonly presented with acute fever and an extremely high incidence of adverse pregnancy outcomes,however empiric antibiotics can hardly cover this pathogenic bacterium.So both pregnant women and clinicians should maintain a high level of vigilance against listeriosis and pay more attention to dietetic hygiene.