妊娠期慢性乙型肝炎55例

Pregnant women with chronic hepatitis B:an analysis of 55 cases

目的:分析妊娠期慢性乙型肝炎发病特点和临床特征.方法:回顾性分析55例妊娠期慢性乙型肝炎患者的临床资料,并与妊娠期乙型肝炎携带者(无症状妊娠组)及正常妊娠女性进行临床比较.结果:妊娠期慢性乙型肝炎发病集中于妊娠的中、晚期.与无症状妊娠组比较,慢乙型肝炎妊娠组患者肝功能损害表现为ALT、AST、TBIL及DBIL明显升高(210.2U/L±144.7U/L vs22.7U/L±11.6U/L;197.3U/L±113.8U/L vs19.1U/L±14.9U/L;64.9μmol/L±37.8μmol/L vs6.8μmol/L±5.8μmol/L;44.2μmol/L±23.8μmol/L vs4.8μmol/L±2.2μmol/L,均P<0.05),白蛋白、PTA降低(31.3G/L±7.3G/L vs35.8G/L±4.7G/L;66.4%±8.6%vs82.1%±8.7%,均P<0.05).患者的病毒学特征表现为HBeAg阳性和HBV DNA高滴度.结论:妊娠期慢性乙型肝炎的发生多集中于妊娠的中、晚期;临床类型以中、重度为主;HBeAg阳性和HBV DNA高滴度可作为妊娠期慢性乙型肝炎发生的预测指标.

AIM：To analyze the clinical and pathological characteristics of chronic hepatitis B in pregnancy and to explore the relationship between pregnancy and hepatitis B virus （HBV） infection. METHODS：The clinical data of 55 pregnant women with chronic hepatitis B were retrospectively analyzed and compared with those of pregnant HBV carriers and normal pregnant women. The clinical and pathological characteristics of chronic hepatitis B in pregnancy were then analyzed. RESULTS：The morbility of hepatitis increased gradually with the increase in pregnancy du-ration. Compared with pregnant HBV carriers,ALT,AST,TBIL and DBIL significantly increased （210.2 U/L ± 144.7 U/L vs 22.7 U/L ± 11.6 U/L,197.3 U/L ± 113.8 U/L vs 19.1 U/L ± 14.9 U/L,64.9 μmol/L ± 37.8 μmol/L vs 6.8 μmol/L ± 5.8 μmol/L,and 44.2 μmol/L ± 23.8 μmol/L vs 4.8 μmol/L ± 2.2 μmol/L,respectively; all P 0.05）,and albumin and PTA decreased signif icantly （31.3 G/L ± 7.3 G/L vs 35.8 G/L ± 4.7 G/L; 66.4% ± 8.6% vs 82.1% ± 8.7%,both P 0.05） in pregnant women with chronic hepatitis B. The rates of HBeAg positivity and high HBV DNA load were especially higher in pregnant women with chronic hepatitis B than in other groups of subjects. CONCLUSION：HBV infection in pregnant women occurs mainly during the middle to late stages of pregnancy. Many cases of chronic hepatitis B in pregnancy are serious. HBeAg positivity and high HBV DNA load could be used as parameters for predicting the occurrence of HBV infection.