妊娠期伴发乙型肝炎病毒与母婴结局的关系

Relationship between HBV infection in pregnancy and maternal,neonatal outcomes

目的探析乙型肝炎病毒(HBV)感染与妊娠结局的关系。方法分析分娩、产前检查以及孕期初诊的42例HBV感染(血清HBs Ag阳性)孕妇的临床资料,选取同期62例肝功能正常的血清HBs Ag阴性孕妇作为对照组,根据丙酸氨基转氨酶(ALT)水平把患者分为肝功能正常组29例和肝功能异常组13例,比较3组的基线资料、分娩、妊娠并发症情况以及婴儿围生期结局情况。结果 3组孕妇的孕周、孕次、年龄间差异无统计学意义(P>0.05)。3组孕妇妊娠并发症中产后出血、胎膜早破、妊娠期高血压、胎儿窘迫、早产的发生率异常组最高,对照组最低。异常组和对照组相比,产后出血、早产以及妊娠期高血压发生率差异有统计学意义(P<0.05),胎膜早破及胎儿窘迫的发生率差异无统计学意义(P>0.05);正常组妊娠并发症的发生率与对照组差异无统计学意义(P>0.05)。3组孕妇的剖宫产率差异无统计学意义(P>0.05)。3组孕妇婴儿围生期结局中,异常组出现死胎、低体重儿和新生儿窒息的几率最高,其中低体重儿的发生率与对照组差异有统计学意义(P<0.05)。结论伴发HBV感染的妊娠对母婴结局的影响不良,特别是肝功能异常孕妇对母婴的危害更大。

Objective To explore the relationship between hepatitis B virus （HBV） infection and pregnancy outcome. Methods The clinical data of 42 pregnant women with HBV infection （positive serum HBsAg） diagnosed at the first visit during delivery, prenatal examination, and pregnancy were analyzed; 62 pregnant women with normal liver function and negative serum HBsAg were selected as control group during the same period. Forty-two patients were divided into normal liver function group （29 cases） and abnormal liver function group （13 cases） according to alanine aminotransferase （ALT） level; the baseline data, delivery, pregnancy complications, and perinatal out-comes in the three groups were compared. Results There was no statistically significant difference in pregnancy week, gravidity, and age among the three groups （ P〉0. 05 ） . Among the pregnancy complications, the incidence rates of postpartum hemorrhage, premature rupture of fetal membrane, hypertensive disorder complicating pregnancy （premature delivery）, fetal distress, and premature delivery in abnormal liver function group were the highest, while in control group, the incidence rates of the above-mentioned indexes were the lowest. There were statistically significant differences in the incidence rates of postpartum hemorrhage, premature delivery, and premature delivery between abnormal liver function group and control group （P〈0. 05 ）, but there was no statistically significant difference in the incidence rates of premature rupture of fetal membrane and fetal distress between the two groups （P〉0. 05 ） ; there was no statistically significant difference in the incidence rates of pregnancy complications between normal liver function group and control group （ P〉0. 05 ） . There was no statistically significant difference in cesarean section rate among the three groups （P〉0. 05 ） . Among perinatal outcomes, the incidence rates of stillbirth, low weight infants, and neonatal asphyxia in abnormal liver function group were the highest, there was statistically significant difference in the incidence rate of low weight infants between abnmlnal liver function group and control group （ P〈0. 05 ） . Conclusion HBV infection in pregnancy has adverse impact on maternal and neonatal outcomes, especially the pregnant women with abnormal liver function.