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浙江大学学报(医学版)  2020, Vol. 49 Issue (2): 240-244    DOI: 10.3785/j.issn.1008-9292.2020.03.08
原著     
三例妊娠合并2019冠状病毒病(COVID-19)患者诊治分析
陈旭1(),李央1,*(),王金希1,蔡洪流2,曹红翠3,盛吉芳3
1. 浙江大学医学院附属第一医院妇产科, 浙江 杭州 310003
2. 浙江大学医学院附属第一医院重症医学科, 浙江 杭州 310003
3. 浙江大学医学院附属第一医院感染科, 浙江 杭州 310003
Pregnant women complicated with COVID-19: a clinical analysis of 3 cases
CHEN Xu1(),LI Yang1,*(),WANG Jinxi1,CAI Hongliu2,CAO Hongcui3,SHENG Jifang3
1. Department of Obstetrics and Gynecology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
2. Department of Critical Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
3. Department of Infectious Diseases, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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摘要:

目的: 研究妊娠合并2019冠状病毒病(COVID-19)患者的临床特点及妊娠结局。方法: 对浙江大学医学院附属第一医院2020年1月19日至2月10日收治的3例妊娠合并COVID-19患者的临床表现、辅助检查、治疗经过、妊娠结局进行回顾性分析。结果: 3例患者早孕(例1)、中孕(例2)、晚孕(例3)各1例,例1和例3为COVID-19普通型,例2为COVID-19重型;以咳嗽、发热、乏力、肺部影像学改变为主要表现,例1、例3实验室检查提示白细胞计数、淋巴细胞百分比等无明显变化,炎症指标如C反应蛋白、红细胞沉降率、IL-6、IL-10等轻度升高,例2淋巴细胞计数及淋巴细胞百分比明显降低,炎症因子水平明显升高。3例患者经过抗病毒、止咳、吸氧等综合治疗,其中例2使用糖皮质激素和丙种球蛋白调节免疫治疗,例3使用糖皮质激素,均符合出院标准。例1出院后选择终止妊娠;例2无产科并发症选择继续妊娠;例3因胎心监护异常行剖宫产终止妊娠,母胎情况良好。结论: 妊娠合并COVID-19患者经积极治疗可以痊愈,母胎结局良好,但对子代的影响仍需进一步研究。

关键词: 2019冠状病毒病严重急性呼吸综合征冠状病毒2新型冠状病毒肺炎妊娠妊娠结局    
Abstract:

Objective: To analyze the clinical characteristics and pregnancy outcomes of pregnant women complicated with coronavirus disease 2019 (COVID-19). Methods: The clinical data of 3 pregnant women with COVID-19 admitted to the First Affiliated Hospital of Zhejiang University School of Medicine from January 19 to February 10, 2020 were retrospectively analyzed. Results: There was one case in the first-trimester pregnancy (case 1), one in the second-trimester pregnancy (case 2) and one in third-trimester pregnancy (case 3). Cough, fever, fatigue, lung imaging changes were the main manifestations. The white cell count, lymphocyte percentage had no significantly changes in case 1 and case 3, while the levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), IL-6 and IL-10 elevated. The lymphocyte count and lymphocyte percentage decreased and the inflammatory indicators significantly increased in case 2. All patients were treated with antiviral, antitussive, oxygen inhalation; case 3 received glucocorticoids, case 2 with severe illness received glucocorticoids and additionally gamma globulin. All three cases were cured and discharged. Case 1 with early pregnancy chose to terminate pregnancy after discharge; case 2 chose to continue pregnancy without obstetric complications; and case 3 had cesarean section delivery due to abnormal fetal heart monitoring. Conclusion: The report shows that COVID-19 in pregnancy women could be cured with active treatment, and the maternal and fetal outcomes can be satisfactory.

Key words: Coronavirus disease 2019    Severe acute respiratory syndrome coronavirus 2    Novel coronavirus pneumonia    Pregnancy    Pregnancy outcome
收稿日期: 2020-02-28 出版日期: 2020-03-17
:  R714.251  
通讯作者: 李央     E-mail: 1517009@zju.edu.cn;liyang2014@zju.edu.cn
作者简介: 陈旭(1990—), 男, 硕士, 住院医师, 主要从事产科疾病诊治和发病机制研究; E-mail:1517009@zju.edu.cn; https://orcid.org/0000-0003-3652-3455
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引用本文:

陈旭,李央,王金希,蔡洪流,曹红翠,盛吉芳. 三例妊娠合并2019冠状病毒病(COVID-19)患者诊治分析[J]. 浙江大学学报(医学版), 2020, 49(2): 240-244.

CHEN Xu,LI Yang,WANG Jinxi,CAI Hongliu,CAO Hongcui,SHENG Jifang. Pregnant women complicated with COVID-19: a clinical analysis of 3 cases. J Zhejiang Univ (Med Sci), 2020, 49(2): 240-244.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2020.03.08        http://www.zjujournals.com/med/CN/Y2020/V49/I2/240

实验室检查项目 正常值范围 例1 例2 例3
  1 mmHg=0.133 kPa.COVID-19:2019冠状病毒病.
白细胞计数(×109/L) 4.0~10.0 5.1 7.5 8.2
中性粒细胞百分比(%) 50~70 61.8 85.2 81.4
淋巴细胞计数(×109/L) 0.8~4.0 1.4 0.4 0.9
淋巴细胞百分比(%) 20~40 26.6 10.8 12.9
红细胞沉降率(mm/1h) 0~20 30 75 34
C反应蛋白(mg/L) 0~10 17 50.95 11.76
IL-6(pg/mL) 0.1~2.9 23.04 458.59 21.93
IL-10(pg/mL) 0.1~5.0 6.66 8.83 7.89
丙氨酸转氨酶(U/L) 7~40 13 17 12
天冬氨酸转氨酶(U/L) 13~35 11 15 17
肌酐(μmol/L) 41~73 64 50 46
呼吸频率(次/min) 16~20 18 25 20
氧分压(mmHg) 80~110 107 90.8 174
氧饱和度(%) 91~99 97 92 97
氧合指数(mmHg) 400~500 462 279 527
表 1  3例妊娠合并COVID-19患者入院时实验室检查结果
图 1  3例妊娠合并COVID-19患者入院时肺部CT表现
例序 抗病毒 糖皮质激素 丙种球蛋白 氧疗
  *甲泼尼龙首次40~80 mg/d,症状控制3~4 d后,按1/2~1/3量给药,每3~4 d减1次,逐渐减量,直至停用并酌情改为口服.
例1 阿比多尔200 mg口服,3次/d,共8 d; 洛匹那韦/利托那韦160 mg/40 mg口服,2次/d,共8 d 持续鼻导管吸氧3 L/min,共8 d
例2 洛匹那韦/利托那韦160 mg/40 mg口服,2次/d,共12 d 首次甲泼尼龙80 mg静脉滴注,1次/d* 丙种球蛋白20 g静脉滴注,1次/d,共5 d 持续鼻导管吸氧3 L/min,共16 d
例3 洛匹那韦/利托那韦160 mg/40 mg口服,2次/d,共9 d 首次甲泼尼龙40 mg静脉滴注,1次/d* 鼻导管吸氧3 L/min,每次30 min,3次/d,共10 d
表 2  3例妊娠合并2019冠状病毒病患者住院期间主要治疗情况
1 WONG S F , CHOW K M , LEUNG T N et al. Pregnancy and perinatal outcomes of women with severe acute respiratory syndrome[J]. Am J Obstet Gynecol, 2004, 191 (1): 292- 297
doi: 10.1016/j.ajog.2003.11.019
2 中华人民共和国国家卫生健康委员会办公厅, 国家中医药管理局办公室.新型冠状病毒感染的肺炎诊疗方案(试行第六版)[A/OL].国卫办医涵〔2020〕145号.(2020-02-18)[2020-02-28].http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml.
General Office of National Health Commission of the People's Republic of China, Office of National Administration of Traditional Chinese Medicine. Diagnosis and treatment of novel coronavirus pneumonia (trial version 6)[A/OL]. No.145〔2020〕 of the General Office of the National Health Commission. (2020-02-18)[2020-02-28]. http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml. (in Chinese)
3 LU R , ZHAO X , LI J et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding[J]. Lancet, 2020, 395 (10224): 565- 574
doi: 10.1016/S0140-6736(20)30251-8
4 LAM C M , WONG S F , LEUNG T N et al. A case-controlled study comparing clinical course and outcomes of pregnant and non-pregnant women with severe acute respiratory syndrome[J]. BJOG, 2004, 111 (8): 771- 774
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