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目的总结体外受精和胚胎移植(IVF-ET)后妊娠发生急性粟粒性肺结核的临床特点。方法回顾性分析2001年1月至2005年12月在浙江大学医学院附属妇产科医院生殖中心接受IVF-ET 后妊娠并发粟粒性肺结核的6例临床资料。结果 IVF-ET 后妊娠并发粟粒性肺结核患者的临床表现多不典型,以发热为主要表现,呼吸道症状隐匿。胸部影像学表现以粟粒性结节和浸润性改变为主。平均于移植后53.2 d 发病,1例人工流产终止妊娠,其余5例均在发病后2～4周内发生自然流产。结论发热为急性粟粒性肺结核的主要临床表现,IVF-ET 后妊娠发生粟粒性肺结核的妊娠结局差,对抗炎治疗无效的发热患者应警惕肺结核,尽早行结核病的相关检查。
Objective To summarize the clinical features of acute miliary tuberculosis in pregnancy after in vitro fertilization and embryo transfer (IVF-ET). Methods The clinical data of 6 cases of pregnancy complicated with miliary tuberculosis after receiving IVF-ET in Reproductive Center of Obstetrics and Gynecology Hospital of Zhejiang University from January 2001 to December 2005 were retrospectively analyzed. Results The clinical manifestations of miliary tuberculosis complicated with pregnancy after IVF-ET were mostly atypical, with fever as the main manifestation and respiratory symptoms as obscure. Chest imaging findings were mainly miliary nodules and infiltrative changes. The average incidence of 53.2 d after transplantation, 1 case of abortion termination of pregnancy, and the remaining 5 cases occurred within 2 to 4 weeks after the onset of spontaneous abortion. Conclusions Fever is the main clinical manifestation of acute miliary tuberculosis. The pregnancy outcome of miliary tuberculosis after IVF-ET pregnancy is poor. Patients with fever who are ineffective in anti-inflammatory therapy should be alert to tuberculosis, and tuberculosis should be checked as soon as possible.