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目的探讨改善妊娠合并人类免疫缺陷病毒(HIV)感染者不良结局的相关因素。方法对2009年5月至2010年5月广州市第八人民医院收治的65例HIV感染孕妇的临床情况进行分析,并对以下分组妊娠结局进行比较(65例中终止妊娠10例,仅对余55例进行分析)。(1)全程实施母婴阻断措施的39例为研究组,未全程实施母婴阻断措施的16例为对照组。(2)研究组中,孕13~27+6周开始实施母婴阻断措施的23例为中孕期组,孕28周后开始实施母婴阻断措施的16例为晚孕期组。(3)产前7d内末梢血CD4+ T淋巴细胞数大于200个/μL者为A组,小于200个/μL者为B组。结果 (1)研究组与对照组早产、低体重儿、胎膜早破、羊水过少、胎儿畸形、胎儿窘迫发生情况比较,除胎儿窘迫外,差异均有统计学意义(P<0.05)。(2)中孕期组与晚孕期组早产、低体重儿、羊水过少、胎儿窘迫、胎膜早破发生情况比较,除胎膜早破外,差异均有统计学意义(P<0.05)。(3)A组与B组早产、低体重儿、胎儿窘迫、羊水过少、胎儿畸形和产后发热发生情况比较,差异均有统计学意义(P<0.05)。结论婚前检查和产前筛查、孕妇末梢血CD4+ T淋巴细胞数、全程母婴阻断措施和有效咨询及随访与改善HIV感染孕妇不良结局具有相关性。
Objective To explore the related factors to improve the adverse outcomes of pregnancy complicated with human immunodeficiency virus (HIV) infection. Methods The clinical data of 65 cases of HIV-infected pregnant women admitted to the Eighth People’s Hospital of Guangzhou from May 2009 to May 2010 were analyzed and the pregnancy outcomes were compared among the following groups (10 of 65 cases terminated pregnancy, 55 cases for analysis). (1) Thirty-nine cases of maternal-child block were enrolled in the study group, and 16 cases without maternal-child blockage were the control group. (2) Twenty-three pregnant women and young pregnant women in the study group who started the maternal-fetal blockade during the period from 13-27 weeks to 6 weeks of pregnancy were in the second trimester group. (3) A group of more than 200 cells / μL of peripheral blood CD4 + T lymphocytes within 7 days prepartum, group B less than 200 cells / μL. Results (1) The incidence of preterm birth, low birth weight infants, premature rupture of membranes, oligohydramnios, fetal malformation and fetal distress in study group and control group were significantly different except fetal distress (P <0.05). (2) There were significant differences in the incidence of premature labor, low birth weight infants, oligohydramnios, fetal distress and premature rupture of membranes in the second trimester pregnancy group and the second trimester pregnancy group, except for premature rupture of membranes (P <0.05). (3) There were significant differences between preterm and low birth weight children, fetal distress, oligohydramnios, fetal malformation and postpartum fever in group A and group B (P <0.05). Conclusion Prenatal and prenatal screening, peripheral blood CD4 + T lymphocytes in pregnant women, full maternal and neonatal blockade measures and effective counseling and follow-up are associated with improving adverse outcomes of HIV-infected pregnant women.