Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
Department of Pulmonary and Critical Care Medicine, Xining Second People's Hospital, Xining, China.
Ann Med. 2022 Dec;54(1):71-79. doi: 10.1080/07853890.2021.2018485.
Pregnancy complicated with tuberculosis is increasingly common. The clinical characteristics of pregnancy complicated with miliary tuberculosis are summarized in this study.
A retrospective analysis of pregnant patients with miliary tuberculosis was performed in terms of epidemiology, demography, clinical characteristics, laboratory tests, treatment, and prognosis.
Of the 23 patients that were included, 12 became pregnant after fertilization combined with embryo transfer (IVF-ET). The average gestational age at symptom onset was 13.96 weeks, and the average time from symptom onset to diagnosis was 33 days. Clinical symptoms included fever, dyspnoea, cough, headache, abdominal pain, and chest pain. Extrapulmonary tuberculosis occurred in 10 patients, respiratory failure in 11 patients, and ARDS in 9 patients. Chest HRCT showed diffusely distributed miliary nodules in all patients. Six patients were on mechanical ventilation, two underwent ECMO, and one died. Symptoms appeared in the first trimester of nine pregnancies after IVF-ET and in the second trimester of seven natural pregnancies.
Miliary tuberculosis can occur in pregnant patients, especially in patients after IVF-ET. Symptoms often appear in the first trimester of pregnancy after IVF-ET and in the second trimester of natural pregnancy. Lacking specificity, the common clinical characteristics include elevated inflammation markers, anaemia, low lymphocyte count, and multiple miliary nodules shown on a chest HRCT scan. Half of patients with miliary tuberculosis may develop respiratory failure, and some may progress to ARDS. Therefore, infertile patients should be required to undergo TB screening before undergoing IVF-ET, and preventive anti-TB treatment should be given to patients with latent TB infections or untreated TB disease.Key MessageMiliary tuberculosis can occur in pregnant patients, especially in pregnant patients after IVF-ET. Symptoms often appear in the first trimester of pregnancy after IVF-ET and in the second trimester of natural pregnancy. Many patients develop respiratory failure or ARDS.
妊娠合并结核病的发病率呈逐渐上升趋势。本研究总结了妊娠合并粟粒性肺结核的临床特点。
对 23 例妊娠合并粟粒性肺结核患者的流行病学、人口学、临床特征、实验室检查、治疗及预后进行回顾性分析。
23 例患者中，12 例为体外受精-胚胎移植（IVF-ET）后妊娠，发病平均孕周为 13.96 周，从症状出现到诊断的平均时间为 33 天。临床表现主要为发热、呼吸困难、咳嗽、头痛、腹痛和胸痛。10 例患者并发肺外结核，11 例患者发生呼吸衰竭，9 例患者发生急性呼吸窘迫综合征。所有患者胸部高分辨率 CT 均显示弥漫性分布的粟粒状结节。6 例患者行机械通气，2 例行体外膜肺氧合，1 例死亡。9 例 IVF-ET 后妊娠的患者症状出现在妊娠早期，7 例自然妊娠的患者症状出现在妊娠中期。
粟粒性肺结核可发生于妊娠患者，尤其是 IVF-ET 后妊娠患者。IVF-ET 后妊娠的患者症状常出现在妊娠早期，自然妊娠的患者症状常出现在妊娠中期。粟粒性肺结核缺乏特异性，常见的临床特征包括炎症标志物升高、贫血、淋巴细胞计数降低、胸部高分辨率 CT 扫描显示多发粟粒状结节。半数粟粒性肺结核患者可能发生呼吸衰竭，部分患者可能进展为急性呼吸窘迫综合征。因此，对于行 IVF-ET 的不孕患者，应进行结核筛查，对于潜伏性结核感染或未治疗的结核患者，应给予预防性抗结核治疗。
妊娠合并粟粒性肺结核可发生于妊娠患者，尤其是 IVF-ET 后妊娠患者。IVF-ET 后妊娠的患者症状常出现在妊娠早期，自然妊娠的患者症状常出现在妊娠中期。许多患者发生呼吸衰竭或急性呼吸窘迫综合征。
