妊娠妇女乙型肝炎病毒感染的临床特征

Clinical features of pregnant women with hepatitis B virus infection

目的探讨妊娠妇女乙型肝炎病毒(HBV)感染的肝功能、病毒学特点。方法对我院HBV感染的孕妇共259例资料进行回顾性分析,与60例慢性HBV感染未妊娠妇女相比较。用电化学发光法检测乙型肝炎两对半定量、荧光定量PCR法检测HBV DNA定量。结果 33.98%患者有HBV感染的家族史;非妊娠妇女的ALT、AST水平均较妊娠妇女明显升高;71.81%HBV感染的妊娠妇女肝功能正常,慢性乙型肝炎重度7例(2.70%);慢性乙型肝炎重型3例(1.16%);59.85%患者HBeAg(+),HBV DNA水平>5 log10 IU/ml患者63.71%,HBeAg阳性组孕妇的ALT、AST水平、HBV DNA定量较阴性组患者明显升高;HBeAg阳性组孕妇中,随着HBV DNA水平升高,ALT水平明显升高伴统计学意义,HBeAg阴性组孕妇中,随着HBV DNA水平升高,ALT、AST水平亦明显升高伴统计学意义;HBV DNA定量>5 log10 IU/ml妊娠妇女中高达46.06%ALT、AST水平升高。HBeAg阳性比例小于28岁的年轻孕妇(65.49%)显著高于年长孕妇(52.99%),28岁以上的年长孕妇发生肝功能损害发生率(34.19%)显著高于年轻孕妇(20.42%)。结论妊娠妇女HBV感染患者以HBeAg(+)为主,占59.85%,HBV DNA水平>5 log10 IU/ml者为多,占63.71%;71.81%患者肝功能正常;HBeAg阳性孕妇,肝功能异常较阴性患者明显,HBV DNA水平亦明显升高;无论是HBeAg阳性还是阴性患者,随着HBV DNA水平的升高,更容易出现肝损害;HBV DNA定量>5 log10 IU/ml妊娠妇女中46.06%肝功能异常。28岁以下年轻孕妇HBeAg阳性率65.49%高于年长孕妇,但肝功能异常率20.42%,低于年长孕妇。因此对HBV感染的孕妇需要密切观察肝功能、HBV DNA、HBeAg水平,特别是HBeAg阳性和HBV DNA水平较高的妊娠妇女需要警惕肝炎活动。建议HBV感染的女性28岁以前妊娠减少肝功能损害的风险。孕妇HBV感染的临床特征与母婴传播阻断的关系有待进一步探讨。

Objective To study liver function and virus features of the pregnant women with hepatitis B virus （HBV） infection. Methods 259 pregnant women with HBV infection in our hospital were retrospectively analyzed, and compared with 60 non-pregnant women with chronic HBV infection. HBV serological markers were examined by electrochemiluminescence. HBV DNA levels were detected by fluorescent quantitative PCR. Results 33.98%of the patients had family history with HBV infection. ALT and AST were much higher in non-pregnant women than in pregnant women. The liver function was normal in 71.81%of the pregnant women with HBV infection, including 7 cases （2.70%） with chronic severe hepatitis B and 3 cases （1.16%） with liver failure. 59.85%of the patients were HBeAg positive and 63.71%of the patients were with HBV DNA＆gt;5 log10 IU/ml. ALT, AST and HBV DNA levels were much higher in HBeAg＋ pregnant women than in HBeAg-pregnant women. In HBeAg＋pregnant women, ALT increased significantly with the increased HBV DNA levels. In HBeAg-pregnant women, ALT and AST were in the same situation. And the proportion of ALT and AST increased was 46.06% in the pregnant women with HBV DNA level＆gt;5 log10 IU/ml. The HBeAg positive rate （65.49%） was significantly higher in less than 28 years old young pregnant women than the older pregnant women（52.99%）, while the liver function damage rate （20.42%）was lower than that of the older women（34.19%）. Conclusions Pregnant women were characterized by HBeAg＋ （59.85%） and HBV DNA＆gt;5 log10 IU/ml（63.71%）. 71.81%of the patients were with normal liver function. In HBeAg positive pregnant women, abnormal liver function were more serious than in HBeAg negative pregnant women, and HBV DNA levels significantly increased. Whether HBeAg positive or negative, with the increased HBV DNA levels, liver damages were more often. Liver function was abnormal in 46.06%pregnant women with HBV DNA levels＆gt;5 log10 IU/ml. In less than 28 years old young pregnant women the HBeAg positive rate （65.49%） was significantly higher than the older pregnant women, but the liver function damage rate （20.42%） reduced. Therefore the pregnant women with HBV infection should be closely observed by liver function, HBV DNA levels, HBeAg levels. Especially hepatitis should by prevented in the pregnant women with positive HBeAg and high HBV DNA levels. If pregnant before 28 years old for the women infected with HBV, the liver function damage will be reduced. The relationship of clinical features of the pregnant women with hepatitis B virus （HBV） infection and Mother to child transmission blocking needs further research.