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不孕与体外受精-胚胎移植中的结核病。

Tuberculosis in infertility and in vitro fertilization-embryo transfer.

机构信息

Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Research Center for Chronic Airway Diseases, Peking University Health Science Center, Beijing 100191, China.

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

出版信息

Chin Med J (Engl). 2024 Oct 20;137(20):2404-2411. doi: 10.1097/CM9.0000000000003255. Epub 2024 Aug 22.

Abstract

Tuberculosis (TB) is a prominent infectious disease globally that imposes a substantial health burden. Genital TB (GTB), an extrapulmonary manifestation, leads to complications such as tubal adhesions, blockage, and diminished ovarian function, culminating in infertility, and is recognized as a prevalent cause of infertility in nations with high-burden TB. In regions with low TB rates, infertility and active TB during pregnancy have been reported to be most common among female immigrants from countries with high-burden TB. In the context of TB, pregnant women often exhibit exacerbated symptoms after in vitro fertilization-embryo transfer (IVF-ET), heightening the risk of dissemination. Miliary pulmonary TB and tuberculous meningitis pose a serious threat to maternal and fetal health. This article integrates recent epidemiological data and clinical research findings, delineating the impact of TB on infertility and assisted reproduction and particularly focusing on the diagnosis and treatment of GTB, underscored by the imperative of TB screening before IVF-ET. Our objective is to increase awareness among respiratory and reproductive health professionals, promoting multidisciplinary management to enhance clinical vigilance. This approach seeks to provide patients with judicious reproductive plans and scientifically rigorous pregnancy management, thereby mitigating adverse pregnancy outcomes related to TB activity.

摘要

结核病(TB)是一种全球范围内突出的传染病,对健康造成了重大负担。生殖器结核病(GTB)是一种肺外表现,可导致输卵管粘连、阻塞和卵巢功能下降等并发症,最终导致不孕,被认为是结核病负担高的国家不孕的主要原因。在结核病发病率较低的地区,据报道,来自结核病负担高的国家的移民女性在怀孕期间不孕和活动性结核病最为常见。在结核病背景下,孕妇在体外受精-胚胎移植(IVF-ET)后往往会出现症状加重,增加了传播的风险。粟粒性肺结核和结核性脑膜炎对母婴健康构成严重威胁。本文综合了最近的流行病学数据和临床研究结果,阐述了结核病对不孕和辅助生殖的影响,特别关注 GTB 的诊断和治疗,并强调了在 IVF-ET 前进行结核病筛查的必要性。我们的目的是提高呼吸和生殖健康专业人员的认识,促进多学科管理以增强临床警惕性。这种方法旨在为患者提供明智的生殖计划和科学严谨的妊娠管理,从而减轻与结核病活动相关的不良妊娠结局。

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