探讨妊娠期孕妇单核细胞增多性李斯特菌(LM)感染的临床特征、围生结局及临床处理经验。

选择2016年11月1日与2017年2月28日，四川大学华西第二医院产科收治的2例LM感染孕妇为研究对象。采用回顾性分析方法，对这2例LM感染孕妇的临床病例资料进行分析，包括妊娠期情况、妊娠期LM感染诊治情况及围生期结局。同时，结合相关文献，对妊娠期LM感染的生物学及流行病学特征、诊断及处理、对母儿的影响，以及防治措施，进行复习、总结。

①本组2例LM感染孕妇的妊娠期情况为：No.1孕妇于本院建卡，No.2孕妇于外院建卡，2例孕妇均于建卡医院接受正规产前检查，均有巴氏消毒牛奶食用史，入本院治疗前，均出现发热等上呼吸道感染症状，血常规检查结果均异常。②妊娠期LM感染诊治情况：No.1孕妇通过宫颈分泌物培养结果提示中量LM感染，确诊为妊娠期LM感染；No.2孕妇通过血培养及产时取宫颈分泌物培养结果提示LM呈阳性，确诊为妊娠期LM感染。2例孕妇均接受足够剂量美罗培南(1 g/次×3次/d×14 d)抗感染治疗后，预后良好，并出院。③围生期结局：No.1孕妇于晚孕期发生LM感染，因早产临产、胎儿宫内窘迫，进行急诊剖宫产分娩术，其分娩的新生儿血培养及痰培养结果均提示LM呈阳性。因该例新生儿并发症多、病情危重，家属放弃抢救，于出生后第9天死亡。No.2孕妇于中孕期发生LM感染，胎死宫内后难免流产。

孕妇LM感染临床症状无特异性，常伴有发热，表现为流感样症状，临床诊断较为困难，但是孕妇LM感染对胎儿及新生儿有致命危险。因此，临床提高对妊娠期LM感染的认识，早期诊断、早期积极有效治疗，可明显改善妊娠期LM感染母儿预后。

To explore the clinical features, perinatal outcomes and management of the pregnancy with Listeria monocytogenes (LM) infection.

Two cases of pregnancy with LM infection in Department of Obstetrics, West China Second University Hospital, Sichuan University from November 1, 2016 to February 28, 2017 were selected as research subjects. Their clinical data were reviewed by retrospective method, including pregnancy conditions, diagnosis and treatment of pregnancy with LM infection, and perinatal outcomes. At the same time, combined with relevant literatures, the biological and epidemiologic characteristics, diagnosis and treatment, impacts on mother and child, and prevention methods of LM infection during pregnancy were reviewed and summarized.

①The pregnancy conditions of two cases of pregnancy with LM infection were as follows. No. 1 pregnant woman built patient card in our hospital, and No.2 pregnant woman built patient card in other hospital, and both of them received regular prenatal examinations. Both of them had a history of drinking pasteurized milk. Before the admission to our hospital, they showed symptoms of flu-like illness with fever, and the blood routine examination results showed increased white blood cells. ②The diagnosis and treatment conditions of pregnancy with LM infection in this study were as follows. No.1 pregnant woman was diagnosed as pregnancy with LM infection by cervical secretion culture which showed moderate LM infection. No.2 pregnant woman was confirmed as pregnancy with LM infection by blood culture and cervical secretion culture during production which showed positive LM. Both of them received an adequate course of meropenem (1 g/times×3 times/d ×14 d) for anti-infection treatment and all had good prognosis and discharged from hospital. ③The perinatal outcomes of these two pregnant women were as follows. No.1 pregnant woman developed LM infection in the third trimester of pregnancy, and emergency cesarean section was carried out due to the preterm delivery and fetal distress. The results of blood and sputum culture of neonate by No.1 pregnant woman showed positive LM. Due to many complications and critically condition of the newborn by No.1 pregnant woman, the parents gave up rescue for the newborn, and the newborn died at nine days after birth. No.2 pregnant woman developed LM infection in the second trimester of pregnancy, and spontaneous abortion occurred after intrauterine fetal death.

The clinical symptoms of pregnancy with LM infection were nonspecific, often combined with fever, manifested as flu-like symptoms. Therefore, the diagnosis of pregnancy with LM infection is very difficult. However, pregnancy with LM infection is fatal to the fetus and neonate. So raising the awareness, early diagnosis and effective treatment of pregnancy with LM infection can significantly improve the outcomes of maternal and neonatal.