妊娠期李斯特菌病19例临床分析

摘要

目的 分析妊娠期李斯特菌病孕妇的临床特点和妊娠结局.方法 回顾性分析2010年7月至2017年4月四川大学华西第二医院19例确诊为妊娠期李斯特菌病孕妇的一般情况、临床症状、实验室检查结果、胎盘病理检查结果及妊娠结局等,总结其临床特征及妊娠期李斯特菌病与妊娠结局的关系.结果19例妊娠期李斯特菌病孕妇的中位年龄为29.7岁(19.0~42.0岁);妊娠中期就诊7例,妊娠晚期就诊12例;确诊前中位病程天数为4.8 d(0.5~19.0 d);初诊时的临床表现为发热(17/19)、白细胞计数增高(18/19)、腹痛(12/19)等;检出李斯特菌的标本分别为孕妇血液(11例)、产道分泌物(15例)、胎盘(1例),新生儿全血(4例)、新生儿痰(5例)、新生儿耳道分泌物(1例).19例孕妇的胎盘病理检查均提示"炎症反应",1例诊断为Ⅰ级绒毛膜羊膜炎,4例为Ⅱ级绒毛膜羊膜炎,5例为Ⅲ级绒毛膜羊膜炎,9例为Ⅳ级绒毛膜羊膜炎.19例妊娠期李斯特菌病孕妇的21例胎儿中,3例流产,8例胎死宫内,2例新生儿娩出后即死亡,4例新生儿住院后家属放弃治疗死亡,4例新生儿住院治疗后康复出院.19例孕妇在终止妊娠后均康复出院.结论 妊娠期李斯特菌病起病急,患病孕妇不良妊娠结局的发生率高,初始经验性治疗的有效率低,临床医师应提高对该疾病的认识.%Objective To analyze the clinical characteristics and perinatal outcomes of listeriosis during pregnancy. Methods From July 2010 to April 2017, 70 131 women delivered in West China Second University Hospital.Nineteen cases were confirmed as listeriosis.The clinical symptoms,laboratory results,pathogens,placenta pathology and perinatal outcomes were analyzed retrospectively. Results The median age of the 19 cases was 29.7 (19.0-42.0) years old. The median time before diagnosis was 4.8 (0.5-19.0) days. The main clinical symptoms at first visits were high fever (17/19), increased white blood cells (18/19), abdominal pain (12/19). Listeria was found in samples of mother′s blood (11/19), vaginal secretions(15/19),placenta(1/19),neonatal blood(4/19),neonatal phlegm(5/19)and neonatal ear secretions (1/19),respectively.Inflammation of placenta was identified in all 19 cases.Among the 19 cases,1 was gradeⅠ chorioamnionitis,4 was grade Ⅱ,5 was grade Ⅲand 9 was grade Ⅵ. Only 4 newborn survived after therapy,and others suffered perinatal death,including 8 cases of intrauterine death,3 cases of miscarriage and 6 cases of treatment failure. Conclusions Listeriosis has characteristics of acute onset, quick development and high morbidity during pregnancy. The empiric use of antibiotics might not cover listeria. The understanding of listeriosis should be improved.