摘要
目的:探讨体外受精-胚胎移植后妊娠分娩的新生儿发生先天性肺结核的临床特点及诊治策略。方法:分析1例体外受精-胚胎移植后妊娠分娩先天性肺结核的临床资料,并通过检索“体外受精-胚胎移植后新生儿先天性肺结核”相关文献,总结其临床特点和诊治方案。结果:患儿,女,系体外受精-胚胎移植术后妊娠35^(+2)周剖宫产娩出,生后29 d因“反复发热、气促7 d”入院,伴咳嗽、心率快、肝脏肿大表现。经血液及痰液病原微生物DNA高通量基因分别检测确诊为先天性肺结核,给予异烟肼、利福平、环丝氨酸、利奈唑胺抗结核治疗25 d后病情好转出院。检索后共纳入国内外相关文献12篇,包括18例患儿,结合本病例共纳入19例患儿。患儿起病年龄(37.4±28.2)d,常见起病临床表现依次为呼吸窘迫16例(84.2%)、发热9例(47.4%)、呼吸暂停6例(31.6%)、咳嗽5例(26.3%),其中呼吸暂停均发生于出生胎龄<32周患儿,发热和咳嗽主要发生在矫正胎龄>34周患儿。17例(89.5%)患儿接受四联及以上药物治疗,治愈或明显好转16例(84.2%)。结论:体外受精-胚胎移植后妊娠分娩新生儿先天性肺结核起病晚,病情进展快,临床表现多样且不典型,诊断困难,易漏诊;体外受精-胚胎移植后妊娠分娩的新生儿生后晚期出现呼吸困难且抗感染治疗无效者,需警惕先天性肺结核,痰、血液病原微生物DNA高通量检测有助于病原诊断。
Objective:To explore the clinical characteristics,diagnosis and treatment strategies of congenital tuberculosis in newborns delivered by in vitro fertilization and embryo transfer.Methods:Clinical data of a case of congenital tuberculosis delivered by in vitro fertilization and embryo transfer were analyzed.Literature related to neonatal congenital tuberculosis after in vitro fertilization and embryo transfer were reviewed,clinical characteristics,diagnosis and treatment were summarized.Results:The female infant was delivered by cesarean section at 35^(+2) weeks of pregnancy after in vitro fertilization and embryo transfer.The infant was admitted into the hospital on the 29^(th) day due to“recurrent fever and shortness of breath for 7 d”,accompanied by cough,rapid heart rate and hepatomegaly.The diagnosis of congenital tuberculosis was confirmed by DNA high-throughput genetic testing of blood and sputum pathogenic microorganisms,and the infant was discharged after 25 d of antituberculosis treatment with isoniazid,rifampicin,cycloserine and linezolid.A total of 12 articles at home and abroad were extracted after the retrieval,including 18 children,and a total of 19 children were included in combination with this case.The age of onset was(37.4±28.2)d,the most common manifestations of onset were respiratory distress in 16 cases(84.2%),fever in 9 cases(47.4%),apnea in 6 cases(31.6%)and cough in 5 cases(26.3%).Of which apnea occurred in infant whose gestational age was less than 32 weeks,fever and cough mainly occurred in infant whose corrected gestational age was more than 34 weeks.There were 17 cases(89.5%)treated with four or more combinations of drugs.Totally 16 cases(84.2%)were cured or significantly improved.Conclusion:Congenital tuberculosis after in vitro fertilization and embryo transfer is characterized by late onset and rapid progress.The clinical manifestations are diverse,atypical and difficult to diagnose and easy to misdiagnose.Congenital tuberculosis should be considered in newborns after in vitro
作者
郭敏
傅益永
悦光
习玉峰
杨华
魏国清
张小龙
朱玲
Guo Min;Fu Yiyong;Yue Guang;Xi Yufeng;Yang Hua;Wei Guoqing;Zhang Xiaolong;Zhu Ling(Maternal and Child Health Hospital of Guanghan City,Sichuan Guanghan 618300,China;The Affiliated Women’s and Children’s Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu Women’s and Children’s Central Hospital,Chengdu 611731,China)
出处
《儿科药学杂志》
CAS
2022年第11期45-50,共6页
Journal of Pediatric Pharmacy
关键词
先天性肺结核
体外受精-胚胎移植
新生儿
congenital tuberculosis
in vitro fertilization and embryo transfer
newborns
