妊娠期肝内胆汁淤积症对HBV感染孕妇妊娠不良结局的影响

Influence of intrahepatic cholestasis of pregnancy on adverse pregnancy outcomes of HBV-infected pregnant women

目的探讨妊娠期肝内胆汁淤积症(ICP)对HBV感染孕妇不良妊娠结局的影响。方法回顾性选取2018年3月—2021年3月首都医科大学附属北京佑安医院收治的232例慢性HBV感染孕妇。按照孕期是否存在ICP,分为单纯HBV感染组(n=100)和HBV+ICP组(n=132);根据ICP严重程度将HBV+ICP组进一步分为HBV+轻度ICP组(n=86)和HBV+重度ICP组(n=46)。比较各组妊娠期母体并发症发生率情况,如早产、胎膜早破、妊娠期糖尿病、妊娠期高血压疾病、产后出血(PPH)发生率情况;以及分别比较各组胎儿/新生儿不良结局情况,如胎死宫内、新生儿窒息、羊水Ⅲ度污染(AFⅢ)、新生儿呼吸窘迫综合征、小于胎龄儿(SGA)、转入新生儿重症监护病房、肺炎以及HBV母婴传播(MTCT)发生情况。计量资料多组间比较采用单因素方差分析;计数资料组间比较采用χ^(2)检验、连续校正χ^(2)检验或Fisher精确概率法。结果HBV+ICP组孕妇在孕晚期母体并发症方面,早产、PPH发生率较单纯HBV感染组增加,差异均有统计学意义(χ^(2)值分别为4.169、5.448,P值分别为0.041、0.020);HBV+ICP组孕妇所分娩新生儿在不良妊娠结局方面,新生儿窒息、AFⅢ及SGA发生率较单纯HBV感染组均增加,差异有统计学意义(χ^(2)值分别为5.448、16.567、11.053,P值分别为0.020、<0.001、0.002)。HBV+重度ICP组孕妇所分娩新生儿在不良妊娠结局方面,AFⅢ及SGA发生率较HBV+轻度ICP组增加,差异均有统计学意义(χ^(2)值分别为4.200、4.511,P值分别为0.040、0.034)。结论HBV感染合并ICP孕妇母体及新生儿不良妊娠结局的发生率相较于单纯HBV感染明显升高,且ICP程度越重,新生儿分娩不良结局发生率越高,但ICP对HBV-MTCT未见影响。

Objective To investigate the influence of intrahepatic cholestasis of pregnancy(ICP)on adverse pregnancy outcomes of hepati-tis B virus(HBV)-infected pregnant women.Methods A retrospective analysis was performed for 232 pregnant women with chronic HBV infection who were admitted to Beijing YouAn Hospital,Capital Medical University,from March 2018 to March 2021.According to the pres-ence or absence of ICP,the patients were divided into HBV infection group with 100 patients and HBV+ICP group with 132 patients;ac-cording to the severity of ICP,the patients in the HBV+ICP group were further divided into HBV+mild ICP group with 86 patients and HBV+severe ICP group with 46 patients.The above groups were compared in terms of the incidence rates of maternal complications during pregnancy,such as premature delivery,premature rupture of membranes,gestational diabetes mellitus,hypertensive disorder complicating pregnancy,and postpartum hemorrhage(PPH),as well as the adverse outcomes of fetus/neonate,such as intrauterine fetal death,neonatal asphyxia,amniotic fluid pollution degreeⅢ(AFⅢ),neonatal respiratory distress syndrome,small-for-gestational-age(SGA),admis-sion to the neonatal intensive care unit,pneumonia,and mother-to-child transmission(MTCT)of HBV.A one-way analysis of variance was used for comparison between multiple groups;the chi-square test,the chi-square test with continuity correction or the Fisher’s exact test was used for comparison of categorical data between multiple groups.Results Compared with the HBV infection group in terms of ma-ternal complications in late pregnancy,the HBV+ICP group had significantly higher incidence rates of premature delivery and PPH(χ^(2)=4.169 and 5.448,P=0.041 and 0.020),and in terms of the adverse outcomes of neonates,the HBV+ICP group had significantly higher incidence rates of neonatal asphyxia,AFⅢ,and SGA than the HBV infection group(χ^(2)=5.448,16.567,and 11.053,P=0.020,P<0.001,and P=0.002).In terms of the adverse outcomes of neonates,the HBV+severe ICP group had significantly higher incidence rates of AFⅢand SGA than the HBV+mild ICP group(χ^(2)=4.200 and 4.511,P=0.040 and 0.034).Conclusion Compared with the preg-nant women with HBV infection alone,the pregnant women with HBV infection and ICP have significantly higher incidence rates of adverse pregnancy outcomes in mothers and neonates,and the incidence rate of adverse outcomes in neonates increases with the increase in the sever-ity of ICP.However,ICP has no influence on HBV MTCT.