探讨妊娠期李斯特菌病(listerellosis)患者的临床特点和妊娠结局，以提高产科医师对该病的认识，从而改善患者及其分娩新生儿的预后。

选择2011年4月至2018年8月，于四川省妇幼保健院接受诊治的14例妊娠期李斯特菌病患者为研究对象。采取回顾性分析方法，对其临床病例资料进行分析，包括患者一般情况、临床症状、实验室确诊依据、抗菌药物治疗经过、妊娠结局，以及其胎儿或分娩新生儿的一般情况、分娩活产新生儿的临床症状、治疗经过及预后等。采用Spearman秩相关分析法，对感染单核细胞增多性李斯特菌(LM)的活产新生儿中，皮疹与死亡的关系进行相关性分析。采用Mann-Whitney U检验，对感染LM的活产的治愈和死亡新生儿的抗菌药物首次使用时间进行统计学比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。

①发生李斯特菌病时，这14例患者的年龄为21～40岁，平均为29.3岁；平均孕龄为31^＋2孕周，其中3例发生于中孕期，其余11例均发生于晚孕期。发热与胎动异常是本研究妊娠期李斯特菌病患者的前2位最常见临床表现，分别占85.7%(12/14)和64.3%(9/14)，其他临床表现还包括腹痛(57.1%，8/14)，子宫压痛(35.7%，5/14)等。本研究晚孕期11例妊娠期李斯特菌病患者中，胎儿胎心监护异常及羊水异常各为9例(81.8%，9/11)。②本研究检出的LM标本，分别来源于患者血液、羊水、宫颈分泌物，以及其分娩新生儿血液、脑脊液。这14例患者中，8例胎盘组织病理学检查结果均提示急性绒毛膜羊膜炎。③对这14例患者进行抗感染等治疗后，均痊愈出院，预后良好。但是，其孕育的15例(1例患者为双胎妊娠)胎儿中，活产新生儿为11例(73.3%)，其中治愈为5例，死亡为6例。这15例新生儿(或胎儿)的死亡率为66.7%(10/15)。④相关性分析的结果显示，感染LM的活产新生儿皮疹与死亡存在关联性(r＝0.633，P＝0.036)。感染LM并活产的治愈和死亡新生儿的抗菌药物首次使用时间比较，差异无统计学意义(Z＝—0.471，P＝0.638)。

妊娠期李斯特菌病不具有特征性临床表现，确诊前的经验性抗菌药物治疗效果欠佳。妊娠期李斯特菌病患者经治疗后预后良好，但是其分娩新生儿的预后不良。

To study the clinical characteristics and pregnancy outcomes of listeriosis during pregnancy in order to improve the obstetricians′ understanding of the disease and the prognosis of patients and their newborns.

A total of 14 patients of listeriosis during pregnancy from April 2011 to August 2018 in Sichuan Provincial Hospital for Women and Children, were chosen as research subjects. Their clinical case data were analyzed retrospectively, including general conditions, clinical symptoms, laboratory results, antibiotics treatment and pregnancy outcomes of patients, and general conditions of fetus or newborns, also clinical symptoms, treatments and outcomes of alive newborns. Spearman rank correlation analysis method was used to analyze the correlation between rash and death of alive newborns infected by Listeria monocytogenes (LM). Mann-Whitney U test was used to compare the time of first use of antibacterials between cured and dead newborns who were live birth and infected by LM. This study was in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013.

①The average age of 14 patients of listeriosis during pregnancy was 29.3 years old, ranging from 21 to 40 years old, and the average gestational age at onset was 31^{+ 2} weeks. Three cases of them occurred in the second trimester and the other 11 cases occurred in the third trimester of pregnancy. Fever of patients and fetal movement abnormalities were the most common clinical symptoms of patients of listeriosis during pregnancy, the ratio of these two clinical symptoms were 85.7% (12/14) and 64.3% (9/14), respectively. Other clinical symptoms including abdominal pain (57.1%, 8/14), uterine tenderness (35.7%, 5/14) of patients, etc.. Among the 11 patients of listeriosis during pregnancy in the third trimester, there were 9 cases (81.8%, 9/11) of abnormal of fetal monitoring and 9 cases (81.8%, 9/11) of amniotic fluid. ② The samples of LM detected in our study were blood, amniotic fluid and cervical secretions of patients of listeriosis during pregnancy, and blood and cerebrospinal fluid of their newborns. Among 8 cases of 14 patients of listeriosis during pregnancy who took placenta pathological examinations, all of them were acute chorioamnionitis. ③ All the 14 patients of listeriosis during pregnancy were treated by anti-infection and their prognosis was favorable. However, among 15 cases of fetuses or newborns (including twins) of 14 patients of listeriosis during pregnancy, 11 cases (73.3%) were live births, and among them, 5 cases were cured and 6 cases died. The mortality of 15 fetuses or newborns was 66.7% (10/15). ④The correlation analysis showed that there was a correlation between rash and death of alive newborns infected by LM (r=0.633, P=0.036). There was no significant differences between cured and dead newborns who were live birth and infected by LM in the time of first use of antibacterials (Z=—0.471, P=0.638).

Patients of listeriosis during pregnancy has no specific clinical manifestation. The empirical antibiotic therapy before final diagnosis has poor therapeutic effect. The prognosis of patient of listeriosis during pregnancy after treatment by anti-infection is favorable, but the prognosis of its newborn is poor.