CAJ | 학술논문

目的：探讨妊娠合并水痘的临床特点及母婴临床结局。方法对2008年1月1日至2014年12月31日首都医科大学附属北京地坛医院收治的妊娠期水痘患者（25例）及其新生儿的临床资料进行回顾性分析，对比同期随机非妊娠期水痘患者（50例）的临床资料，总结妊娠合并水痘的临床特点及母婴临床结局。计数资料比较采用χ2检验，计量资料比较采用 t检验。结果妊娠期水痘患者皮疹结痂时间长于非妊娠期水痘患者[（10．1±2．1）d比（5．6±1．4）d，t＝10．941，P＜0．05）]，皮肤细菌感染比例也高于非妊娠期水痘患者[72．0％（18／25）比32．0％（16／50），χ2＝10．761，P＜0．05]，差异均有统计学意义。25例妊娠期水痘患者中，合并糖尿病3例，胎膜早破2例，贫血5例，羊水减少1例。7例孕妇在发热、皮疹明显时分娩，其中3例（12．0％）并发产时出血。25例妊娠期水痘患者经抗病毒、对症支持等治疗均临床治愈。25例妊娠期水痘患者均顺利分娩出新生儿，无流产、死产及新生儿出生缺陷，未观察到先天性水痘。25名新生儿中，4例（16．0％）在出生后2周内发生新生儿水痘，所有新生儿水痘患儿的母亲均在分娩时罹患水痘。新生儿水痘患儿临床表现为，无发热，有典型皮疹，皮疹结痂时间较长[（11．0±2．1） d]，水痘抗体检测均为阴性。4例新生儿水痘患者经积极抗病毒、人免疫球蛋白等治疗均治愈。结论妊娠期合并水痘具有皮肤结痂时间长、易合并皮肤细菌感染等特点。水痘临床症状明显时分娩的母亲可能易出现产时出血。妊娠中后期合并水痘，经治疗不增加新生儿缺陷的发生率。在妊娠晚期尤其是生产时孕妇罹患水痘，其新生儿可能出现水痘，临床症状不典型，经治疗预后良好。
목적：탐토임신합병수두적림상특점급모영림상결국。방법대2008년1월1일지2014년12월31일수도의과대학부속북경지단의원수치적임신기수두환자（25례）급기신생인적림상자료진행회고성분석，대비동기수궤비임신기수두환자（50례）적림상자료，총결임신합병수두적림상특점급모영림상결국。계수자료비교채용χ2검험，계량자료비교채용 t검험。결과임신기수두환자피진결가시간장우비임신기수두환자[（10．1±2．1）d비（5．6±1．4）d，t＝10．941，P＜0．05）]，피부세균감염비례야고우비임신기수두환자[72．0％（18／25）비32．0％（16／50），χ2＝10．761，P＜0．05]，차이균유통계학의의。25례임신기수두환자중，합병당뇨병3례，태막조파2례，빈혈5례，양수감소1례。7례잉부재발열、피진명현시분면，기중3례（12．0％）병발산시출혈。25례임신기수두환자경항병독、대증지지등치료균림상치유。25례임신기수두환자균순리분면출신생인，무유산、사산급신생인출생결함，미관찰도선천성수두。25명신생인중，4례（16．0％）재출생후2주내발생신생인수두，소유신생인수두환인적모친균재분면시리환수두。신생인수두환인림상표현위，무발열，유전형피진，피진결가시간교장[（11．0±2．1） d]，수두항체검측균위음성。4례신생인수두환자경적겁항병독、인면역구단백등치료균치유。결론임신기합병수두구유피부결가시간장、역합병피부세균감염등특점。수두림상증상명현시분면적모친가능역출현산시출혈。임신중후기합병수두，경치료불증가신생인결함적발생솔。재임신만기우기시생산시잉부리환수두，기신생인가능출현수두，림상증상불전형，경치료예후량호。
Objective To investigate the clinical features of varicella and the prognosis in pregnant women and their newborns .Methods Clinical data of pregnant women with varicella zoster virus (VZV) infection (n= 25) and their newborns hospitalized in Beijing Ditan Hospital from 1st Jan .2008 to 31st Dec .2014 were retrospectively analyzed and randomly compared to non‐pregnant women with VZV infection (n=50) .Clinical features and prognosis of varicella in pregnant women and their infants were analyzed .Chi‐square test was used for categorical data and t test was used for quantitative data .Results Time to rash scab of varicella in pregnant women was longer than non‐pregnant women ([10 .1 ± 2 .1] d vs [5 .6 ± 1 .4] d ,t=10 .941 ,P<0 .05) .The rate of bacterial infection in pregnant women was higher than non‐pregnant varicella women (72 .0% [18/25] vs 32 .0% [16/50] ,χ2 = 10 .761 , P < 0 .05) , with statistical significance .Among 25 cases of varicella pregnant women ,the pregnancy complications were observed in 3 cases of diabetes ,2 cases of premature rupture of membranes ,5 cases of anemia and 1 case of oligoamnios .Seven cases out of 25 pregnant women underwent parturition during fever and varicella period ,and 3 cases (12 .0% ) were complicated with intrapartum hemorrhage . Twenty five varicella pregnant women were all cured after antiviral and supportive treatment and gave birth to their babies ,with no abortion ,stillbirth or birth defects .No congenital varicella was observed in newborns .Of the 25 infants ,4 developed (16 .0% ) varicella within 2 weeks after birth and they were all born from mothers who developed varicella around delivery time .The clinical features of neonatal varicella presented with classic rash with no fever .The time to rash scab was longer (11 .0 ± 2 .1) d and antibody test for VZV was negative .All neonates were cured after antiviral and immunoglobulin treatment .Conclusions Longer duration of skin rash scab and higher rate of bacterial infections are the features of varicella in pregnant women .Intrapartum hemorrhage occurrs more commonly in pregnant women with varicella onset around delivery time .Varicella occurring during mid‐pregnancy may not increase the risk of neonatal birth defects after treatment .The newborns whose mothers with varicella onset during perinatal time especially around delivery time may suffer from varicella .The prognosis of neonatal period varicella is good after treatment .