4例肾移植术后妊娠的临床病例分析
柳宛璐;李宇琪;乔福元;吴媛媛;
摘要(Abstract)：
目的:探讨肾移植术后妊娠患者的孕期管理及分娩方式。方法:回顾分析4例肾移植术后妊娠患者的妊娠过程、结局、分娩方式和围产儿结局。结果:4例女性患者均接受同种异体肾移植术,分别于术后5～16年成功妊娠。2例患者早孕期超声发现胚胎停止发育。2例患者孕期给予FK506(他克莫司)、美卓乐(甲泼尼松龙片)和依木兰(巯唑嘌呤片)治疗,FK506浓度2～9ng/ml,其中1例患者孕38~(+1)周行剖宫产术分娩一活女婴,1例孕35~(+5)周胎膜早破,早产经阴分娩一活女婴。随访1～2年,婴幼儿均健康。结论:肾移植术后患者本身及胎儿风险较高,应视为高危妊娠。妊娠前应更换合理的免疫抑制方案,孕期监测FK506浓度,精确调整免疫抑制剂及激素剂量,使其药物浓度保持在治疗窗内,确保患者顺利妊娠及分娩。
关键词(KeyWords)： 肾移植;妊娠;分娩方式
基金项目(Foundation):
作者(Author): 柳宛璐;李宇琪;乔福元;吴媛媛;
Email:
DOI: 10.13283/j.cnki.xdfckjz.2019.04.013
参考文献(References)：
- [1] McKay DB,Josephson MA.Pregnancy in recipients of solid organs-effects on mother and child[J].N Engl J Med,2006,354(12):1281-1293
- [2] Blume C,Pischke S,von Versen-Hoynck F,et al.Pregnancies in liver and kidney transplant recipients:a review of the current literature and recommendation[J].Best Pract Res Clin Obstet Gynaecol,2014,28(8):1123-1136
- [3] Walker CL.Role of hormonal and reproductive factors in the etiology and treatment of uterine leiomyoma[J].Recent Prog Horm Res,2002,57:277- 294
- [4] EBPG Expert Group on Renal Transplantation European best practice guidelines for renal transplantation.Section IV.Long-term management of the transplant recipient.IV[J].Nephrol Dial Transplant,2002,17(1):50-55
- [5] Armenti VT,Constantinescu S.Pregnancy after transplantation[J].Transplant Rev,2008,22(4):223-240
- [6] Chobanian AV,Bakris GL,Black HR,et al.The seventh report of the joint national committee on prevention,detection,evaluation,and treatment of high blood pressure:the JNC 7 report[J].JAMA,2003,289(19):2560-2572
- [7] Deshpande NA,James NT,Kucirka LM,et al.Pregnancy outcomes in kidney transplant recipients:a systematic review and meta-analysis[J].Am J Transplant,2011,11(11):2388-2404
- [8] Bouzeghrane F,Reinhardt DP,Reudelhuber TL,et al.Enhanced expression of fibrillin- 1,a constituent of the myocardial extracellular matrix in fibrosis[J].Am J Physiol Heart CircPhysiol,2005,289:H982- 991