乙型肝炎病毒对体外受精-胚胎移植患者妊娠结局的影响

Effect of hepatitis B virus on pregnancy outcome of patients undergoing in vitro fertilization and embryo transfer

目的探讨乙型肝炎病毒(HBV)对行体外受精-胚胎移植(IVF-ET)助孕患者妊娠结局的影响。方法回顾性分析首都医科大学附属北京地坛医院妇产科2015年1月至2021年6月收治的114例IVF-ET患者,根据患者病史及HBV病原学结果,将入组患者分为HBV感染的研究组(67例)及无肝炎病毒感染的对照组(47例),分析两组患者一般临床资料包括孕早期丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBil)和总胆汁酸(TBA);孕期并发症包括妊娠期糖尿病、妊娠期高血压疾病、妊娠期肝内胆汁淤积症(ICP)、妊娠期甲状腺功能减退、羊水过少、胎盘粘连、前置胎盘、胎膜早破、胎儿宫内窘迫、早产、剖宫产率、产后出血;新生儿结局包括出生体重、新生儿窒息、新生儿缺陷以及新生儿HBV感染。年龄、BMI、实验室指标、出生体重等计量资料两组间比较采用两样本均数比较t检验,妊娠期糖尿病、妊娠期肝内胆汁淤积症(ICP)、妊娠期甲状腺功能减退、胎膜早破、剖宫产率等计数资料采用Pearson卡方检验。经产妇、不良孕史、妊娠期高血压病、羊水过少、前置胎盘、胎盘粘连、胎儿宫内窘迫、早产、产后出血率、新生儿窒息组间比较采用连续校正卡方检验。结果两组患者孕早期ALT、AST、TBil和TBA差异无统计学意义,研究组孕妇较对照组ICP发生率显著增高(20.9%vs.2.13%),差异有统计学意义(χ^(2)=8.515、P=0.004)。而妊娠期糖尿病(47.76%vs.40.43%:χ^(2)=0.601、P=0.438)、妊娠期高血压病(5.97%vs.4.26%:χ^(2)=0.000、P=1.000)、前置胎盘(2.99%vs.2.13%:χ^(2)=0.000、P=1.000)、胎盘粘连(7.46%vs.4.26%:χ^(2)=0.094、P=0.759)、妊娠期甲状腺功能减退(17.91%vs.6.38%:χ^(2)=3.212、P=0.073)、胎儿宫内窘迫(4.48%vs.2.13%:χ^(2)=0.024、P=0.877)、羊水过少(5.97%vs.4.26%:χ^(2)=0.000、P=1.000)、早产(5.97%vs.6.38%:χ^(2)=0.000、P=1.000)、胎膜早破(14.93%vs.8.51%:χ^(2)=1.055、P=0.304)、产后出血(7.46%vs.6.38%:χ^(2)=0.000、P=1.000)、剖宫产率(38.81%vs.25.53%:χ^(2)=2.19、P=0.139)差异均无统计学意义。两组新生儿体重[(2932±425.32)gvs.(3057±412.51)g:t=1.40、P=0.167]和新生儿窒息率(2.27%vs.0%:χ^(2)=0.000、P=1.000),差异均无统计学意义。两组孕妇所产新生儿均未发生出生缺陷,均未发生HBV感染。结论HBV感染可能会造成IVF孕妇罹患ICP风险增加。HBV感染不会增加IVF孕妇其他孕期并发症的发生率。IVF孕妇HBV感染未导致新生儿不良结局。

Objective To investigate the effect of hepatitis B virus(HBV)on the pregnancy outcome of patients with in vitro fertilization and embryo transfer(IVF-ET).Methods Data of 114 patients with IVF-ET treated in the Department of Obstetrics and Gynecology of Beijing Ditan Hospital,Capital Medical University from January 2015 to June 2021 were analyzed,retrospectively.The 114 patients were divided into study group with HBV infection(67 cases)and control group without hepatitis virus infection(47 cases)according to the patients’medical history,etiological examination of HBV.The general clinical data of the two groups[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil)and total bile acids(TBA)in early pregnancy],the pregnancy complications(gestational diabetes mellitus,gestational hypertension disease,intrahepatic cholestasis of pregnancy,thyroid dysfunction during pregnancy,oligohydramnios,placenta accreta,placenta previa,premature rupture of membranes,fetal distress,premature delivery and cesarean section rate,postpartum hemorrhage),neonatal outcome(birth weight,neonatal asphyxia,neonatal defects,HBV infection in neonates)of the two groups were analyzed,respectively.Measurement data such as age,BMI,laboratory indicators and birth weight were compared between the two groups byt-test.The statistical data of gestational diabetes mellitus(GDM),intrahepatic cholestasis of pregnancy(ICP),hypothyroidism of pregnancy,premature rupture of membranes and cesarean section rate were analyzed by PearsonChi-squaretest.Data of multiparous women,adverse pregnancy history,hypertensive disorders during pregnancy,oligohydramnios,placenta previa,placental adhesion,fetal distress,preterm birth,postpartum hemorrhage rate,and neonatal asphyxia were analyzed byChi-squaretest with continuous correction.Results There was no significant difference in ALT,AST,TBil and TBA between patients of the two groups in the first trimester.The incidence of ICP were significantly higher in study group compared with the control group(20.9% vs.2.13%),with significant difference(χ^(2)=8.515,P=0.004).There were no significant differences in gestational diabetes mellitus(47.76% vs.40.43%:χ^(2)=0.601,P=0.438),gestational hypertension(5.97% vs.4.26%:χ^(2)=0.000,P=1.000),placenta previa(2.99% vs.2.13%:χ^(2)=0.000,P=1.000),placental adhesion(7.46% vs.4.26%:χ^(2)=0.094,P=0.759),hypothyroidism during pregnancy(17.91% vs.6.38%:χ^(2)=3.212,P=0.073),fetal distress(4.48% vs.2.13%:χ^(2)=0.024,P=0.877),oligohydramnios(5.97% vs.4.26%:χ^(2)=0.000,P=1.000),premature delivery(5.97% vs.6.38%:χ^(2)=0.000,P=1.000),premature rupture of membranes(14.93% vs.8.51%:χ^(2)=1.055,P=0.304),postpartum hemorrhage(7.46% vs.6.38%:χ^(2)=0.000,P=1.000)and cesarean section rate(38.81% vs.25.53%:χ^(2)=2.19,P=0.139)between study group and control group.There was no significant difference between the two groups in weight of newborn[(2932±425.32)g vs.(3057±412.51)g:t=1.40,P=0.167]and neonatal asphyxia(2.27% vs.0:χ^(2)=0.000,P=1.000).Incidence of birth defects and neonatal HBV infection of the two groups were not statistically significant.No birth defects and HBV infection occurred in neonatus of the two groups.Conclusions HBV infection may increase the risk of ICP in pregnant women with IVF,while does not increase the risk of other pregnancy complications.HBV infection of pregnant women with IVF did not result in adverse neonatal outcomes.