孕妇结核病的临床特征和妊娠结局：一项回顾性队列研究。
Clinical characteristics and pregnancy outcomes in pregnant women with TB: a retrospective cohort study.
机构信息
Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China.
State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, China.
出版信息
Ann Med. 2024 Dec;56(1):2401108. doi: 10.1080/07853890.2024.2401108. Epub 2024 Sep 13.
PURPOSE
The influence of pregnancy on tuberculosis (TB) has not been well studied. This study aimed to investigate the demographics, clinical characteristics and outcomes of pregnant-related TB compared with the general population with TB.
METHODS
We retrospectively analysed medical records of women during pregnancy or within six months postpartum with active TB who were admitted to the West China Hospital between 2011 and 2022. According to age, gender and admission time, the general population with active TB was matched at a ratio of 1:2, and the demographics, clinical characteristics and outcomes were compared.
RESULTS
All the participants in both the pregnant and non-pregnant groups were females, averaging 26 years old, with a majority of Han nationality (72.4% vs. 69.5%, respectively). The two groups were comparable ( < .05). Pregnant TB cases showed higher rates of fever (61% vs. 35%), dyspnoea (39.9% vs. 18.7%), neurological symptoms (34.4% vs. 11.0%) and miliary TB (24.5% vs. 10.9%) compared to non-pregnant cases ( < .05). Additionally, the pregnant group exhibited lower red blood cell counts (3.62 × 10/L vs. 4.37 × 10/L), lower albumin levels (31.20 g/L vs. 40.40 g/L) and elevated inflammatory markers ( < .05). Pregnant women with TB had severe outcomes, with 16.3% requiring intensive care unit (ICU) care and a 3.3% TB-related mortality rate - higher than local averages. In contrast, the non-pregnant group had lower rates (0.8% for ICU admission, and no TB-related deaths). Moreover, active TB during pregnancies led to a high rate of spontaneous abortion (34.1%), with military pulmonary TB identified as the sole risk factor for severe TB in pregnancies (OR: 3.6; 95% CI: 1.15, 11.34).
CONCLUSIONS
Manifestations of TB in pregnant women differ from those in the general population with TB. Pregnancy complicated with active TB greatly harms the mother and foetus and requires special attention in the future.
目的
妊娠对结核病（TB）的影响尚未得到很好的研究。本研究旨在调查与一般人群的 TB 相比，与妊娠相关的 TB 的人口统计学、临床特征和结局。
方法
我们回顾性分析了 2011 年至 2022 年间在华西医院住院的妊娠期或产后 6 个月内患有活动性 TB 的女性的病历。根据年龄、性别和入院时间，将一般人群的活动性 TB 按 1:2 的比例匹配，并比较其人口统计学、临床特征和结局。
结果
两组均为女性，平均年龄为 26 岁，主要为汉族（分别为 72.4%和 69.5%）。两组在这些方面无显著差异（>.05）。与非妊娠组相比，妊娠 TB 组发热（61%比 35%）、呼吸困难（39.9%比 18.7%）、神经系统症状（34.4%比 11.0%）和粟粒性 TB（24.5%比 10.9%）的发生率更高（<.05）。此外，妊娠组的红细胞计数（3.62×10/L 比 4.37×10/L）、白蛋白水平（31.20 g/L 比 40.40 g/L）较低，炎症标志物升高（<.05）。妊娠合并 TB 的孕妇结局严重，16.3%需要入住重症监护病房（ICU），TB 相关死亡率为 3.3%——高于当地平均水平。相比之下，非妊娠组的入住 ICU 率较低（0.8%），且无 TB 相关死亡。此外，妊娠期间发生活动性 TB 导致自然流产率较高（34.1%），军事性肺结核是妊娠合并严重 TB 的唯一危险因素（OR：3.6；95%CI：1.15，11.34）。
结论
妊娠妇女的 TB 表现与一般人群的 TB 不同。妊娠合并活动性 TB 严重危害母婴健康，未来需要特别关注。
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