未经治疗的既往肺结核会对接受体外受精-胚胎移植的不孕妇女的妊娠结局产生不利影响：一项大型回顾性队列研究。

Untreated Prior Pulmonary Tuberculosis Adversely Affects Pregnancy Outcomes in Infertile Women Undergoing Fertilization and Embryo Transfer: A Large Retrospective Cohort Study.

机构信息

Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China.

Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China;National Clinical Research Center for Obstetrics and Gynecology, Beijing 100191, China.

出版信息

Biomed Environ Sci. 2021 Feb 20;34(2):130-138. doi: 10.3967/bes2021.019.

DOI:10.3967/bes2021.019

PMID:33685572

Abstract

OBJECTIVE

Prior pulmonary tuberculosis (PTB) on chest X-ray (CXR) was commonly found in infertile patients receiving examinations before fertilization and embryo transfer (IVF-ET). It was unclear whether untreated PTB would affect pregnancy outcomes after IVF-ET.

METHOD

We conducted a retrospective cohort study of 14,254 infertile patients who had received IVF-ET at Peking University Third Hospital in 2017. Prior PTB was defined as the presence of signs suggestive of old or inactive PTB on CXR, with or without a clinical TB history. Patients who had prior PTB on CXR but had not received a clinical diagnosis and anti-TB therapy were included for analysis. Live birth, clinical pregnancy, and miscarriage rates were compared between the untreated PTB and non-PTB groups.

RESULTS

The untreated PTB group had significantly lower clinical pregnancy (31.7% . 38.1%) and live birth (23.8% . 30.6%) rates than the non-PTB group (both < 0.001). Multivariate analysis revealed that untreated PTB was a risk factor for decreased live birth rate [odds ratio ( ), 0.80; 95% confidence interval ( ), 0.66-0.98; = 0.028] in all patients and for increased miscarriage ( , 4.19; 95% , 1.69-10.39; = 0.002) and decreased live birth ( , 0.45; 95% , 0.24-0.83; = 0.011) rates in patients with unexplained infertility.

CONCLUSIONS

Untreated PTB was associated with adverse pregnancy outcomes after IVF-ET, especially in patients with unexplained infertility, highlighting the clinical significance of PTB in this specific patient population.

摘要

目的

在接受体外受精-胚胎移植（IVF-ET）前检查的不孕患者中，胸部 X 光（CXR）上常发现既往肺结核（PTB）。未治疗的 PTB 是否会影响 IVF-ET 后的妊娠结局尚不清楚。

方法

我们对 2017 年在北京大学第三医院接受 IVF-ET 的 14254 名不孕患者进行了回顾性队列研究。CXR 上存在提示陈旧或不活动 PTB 的征象，无论是否有临床 TB 病史，均定义为既往 PTB。将 CXR 上存在既往 PTB 但未接受临床诊断和抗结核治疗的患者纳入分析。比较未治疗的 PTB 组和非 PTB 组的活产率、临床妊娠率和流产率。

结果

未治疗的 PTB 组的临床妊娠率（31.7%比 38.1%，均 < 0.001）和活产率（23.8%比 30.6%，均 < 0.001）明显低于非 PTB 组。多变量分析显示，在所有患者中，未经治疗的 PTB 是活产率降低的危险因素（比值比[OR]，0.80；95%置信区间[CI]，0.66-0.98； = 0.028），在不明原因不孕患者中，流产（OR，4.19；95%CI，1.69-10.39； = 0.002）和活产率降低（OR，0.45；95%CI，0.24-0.83； = 0.011）的风险也增加。