妊娠期肝病对围产儿的影响

Influence of hepatic disease in pregnancy on the newborn

目的探讨妊娠期肝病对围产儿的影响,如何预防或减少早产和新生儿窒息率,降低围产儿死亡率。方法对1995至2008年在本院收治并分娩的妊娠期肝病患者1802例及所分娩的新生儿进行回顾性分析。结果1802例妊娠期肝病中,妊娠合并病毒性肝炎1317例,其中以慢性肝炎最多见,占74.0%,其次是急性肝炎,占17.6%,重型肝炎占5.4%,肝炎肝硬化占3.0%。慢性肝炎的围产儿死亡率、新生儿窒息率和早产率分别为0.6%、10.1%和18.5%,重型肝炎分别为23.9%、49.3%和35.2%。重型肝炎与慢性肝炎相比,围产儿死亡率、新生儿窒息率和早产率显著升高(χ2=41.64,P<0.01;x2=29.99,P<0.01;χ2=11.71,P<0.01)。妊娠期特有肝病485例,占妊娠期肝病的18.4%,其中以妊娠期肝内胆汁淤积症(ICP)最多见(310例,占63.9%),妊娠期急性脂肪肝(AFLP)14例,占2.9%。ICP中围产儿死亡率、新生儿窒息率和早产率分别为1.6%、36.8%和57.4%,AFLP中分别为21.4%、78.6%和85.7%。妊娠期急性脂肪肝与肝内胆汁淤积症相比,新生儿窒息率和早产率显著升高(χ2=9.88,P<0.01;χ2=4.42,P<0.05)。34例死亡围产儿的母亲中,乙型肝炎26例,占76.5%,其中重型乙型肝炎有17例,占65.4%。结论最常见的妊娠期肝病是病毒性慢性肝炎和妊娠期肝内胆汁淤积症,对围产儿危害最大的是妊娠合并重型肝炎和妊娠合并急性脂肪肝。

Objective To evaluate the impact of hepatic disease in pregnancy on the newborn, and to investigate the relationship between premature delivery, neonatal asphyxia and perinatal mortality. Methods 1802 cases of hepatic disease in pregnancy and their neonates from 1995 to 2008 in our center were retrospectively analyzed. Results Among 1 802 cases of hepatic disease in pregnancy, 1 317 cases were pregnancy with virus hepatitis. Chronic hepatitis was the most common type, accounted for 74. 0%. The second most common type was acute hepatitis which accounted for 17.6%. Severe hepatitis accounted for 17. 6%, and hepatic cirrhosis accounted for 3. 0%. Perinatal mortality rate, neonatal asphyxia rate and premature delivery rate of chronic hepatitis were 0. 6%, 10. 1% and 18. 5% respectively, which were much higher in severe hepatitis. The rate of perinatal mortality, neonatal asphyxia and premature delivery in severe hepatitis were much higher than those in chronic hepatitis （P〈0.01 for all the comparisons）. 485 cases （18.4%） were special type of hepatic disease in pregnancy, and intrahepatic cholestasis of pregnancy （ICP） was the most common type （63.9%）, Another 14 cases were acute fatty liver of pregnancy （AFLP） （2.9%）. The rates of perinatal mortality, neonatal asphyxia and premature delivery in ICP cases were 1. 6%, 36. 8% and 57.4% respectively, while in AFLP cases, they were 21.4%, 78.6% and 85.7% respectively, and those rates were significantly higher in AFLP than ICP. Among the 34, 26 were hepatitis B （76.5%）, in which 17 were severe type B hepatitis （65.4%）. Conclusion The most predominant type of pregnanthepatic diseases were chronic viral hepatitis and intrahepatic cholestasis . Severe hepatitis and acute fatty liver of pregnancy were most harmfal to the newborns.