单核李斯特菌病临床研究

发布时间：2018-05-05 23:26

本文选题：李斯特菌 + 妊娠　；参考：《北京协和医学院》2015年博士论文

【摘要】：[目的]：探讨综合医院李斯特菌病的临床特点、高危因素及治疗转归,以揭示其发病特点,提高对李斯特菌病的认识。[方法]：以计算机检索系统结合人工检索,对北京协和医院1999年1月～2014年12月经病原学检查确诊的李斯特菌病的临床资料进行回顾性分析,并结合文献复习,以阐述其临床特点和转归。[结果]：1、在1999年1月～2014年12月共收治李斯特菌病病人69例,成人非妊娠相关性、妊娠期和新生儿李斯特菌病各占68.1%、23.2%和8.7%,病例数呈明显增长趋势。2、妊娠期病例年龄(30±3.9)岁,发生在妊娠早、中、晚期分别为1例、8例、7例；临床表现为发热(93.8%)、血白细胞增高(78.6%)、胎盘急性胎膜绒毛膜炎(77.8%)、胃肠道症状(37.5%)、胎动减少或消失(31.3%)等；15例出现不良妊娠结局,导致胎儿死亡8例、新生儿李斯特菌败血症经治疗存活7例；初始经验性抗微生物药物李斯特菌覆盖率低。3、6例新生儿均为播散性感染,除1例早产儿死亡外,5例存活。4、成人非妊娠期李斯特菌病47例,年龄平均(46.6±17.1)岁,男性18例(38.3%)；临床表现为败血症(51.1%)、中枢神经系统感染(25.5%)和败血症和中枢神经系统感染(23.4%)；91.5%病人存在基础病,以自身免疫病(46.8%)、恶性肿瘤(29.8%)多见；经验性抗生素有效覆盖率为27.7%；死亡率36.2%。5、21例(44.7%)的成人非妊娠感染发生在因基础疾病治疗的住院病人中,涉及7个病房,在时间和空间上无聚集现象。[结论]：在北京一家综合性医院近16年收治的69例李斯特菌病主要累及存在基础性自身免疫病、恶性肿瘤的病人及孕妇,尤其是因基础疾病住院中的病人；以败血症、中枢神经系统感染、不良妊娠结局为主要临床表现,经验性抗生素有效覆盖率低,病死率高。因此,李斯特菌病的发病在我国可能被低估,需要提高警惕。
[Abstract]:Objective: to explore the clinical characteristics, high risk factors and therapeutic outcome of Listeria in general hospital, so as to reveal the characteristics of the disease and improve the understanding of Listeria. [methods]: the clinical data of Listeria from January 1999 to December 2014 in Beijing Union Hospital were retrospectively analyzed by computer retrieval system and artificial retrieval, and the literature was reviewed. In order to explain its clinical characteristics and outcome. [results] from January 1999 to December 2014, 69 patients with Listeria disease were admitted to the hospital. The incidence of non-pregnancy related adults was 68.2% and 8.7% respectively during pregnancy and neonatal Listeria. The number of cases showed an obvious increasing trend. The age of the cases during pregnancy was 30 卤3.9 years old. In the early, middle and late trimester of pregnancy, there were 8 cases of early pregnancy, 7 cases of late pregnancy, 7 cases of early pregnancy, 7 cases of late pregnancy, 7 cases of fever 93.8%, 78.6% of leukocytosis, 77.8% of placental acute placental chorionitis, 37.5% of gastrointestinal symptoms, 31.3% of fetal motility decrease or disappearance of fetal movements), and 15 cases of adverse pregnancy outcome. There were 8 cases of fetal death, 7 cases of neonatal listeria septicemia and 6 cases of disseminated infection. In addition to one premature infant death, 5 cases survived, 47 cases of adult non-pregnancy Listeria complicating disease, the average age was 46.6 卤17.1 years old. The clinical manifestations were septicemia (51.1%, central nervous system infection 25.5) and septicemia and central nervous system infection (23.41.5%). The effective coverage rate of empirical antibiotics was 27.7.The mortality rate was 36.2.50.21 cases of adult non-pregnancy infection occurred in the inpatients who were treated with basic diseases, involving 7 wards, and there was no aggregation in time and space. [conclusion]: 69 cases of listeria in a general hospital in Beijing in the last 16 years mainly involve patients with basic autoimmune disease, malignant tumor patients and pregnant women, especially those hospitalized because of basic diseases. Central nervous system infection, adverse pregnancy outcome is the main clinical manifestation, the effective coverage of empirical antibiotics is low, the death rate is high. Therefore, the incidence of Listeria may be underestimated in China, need to be vigilant.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R517.7

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