乙型肝炎病毒感染孕妇病毒载量对妊娠期糖尿病发病的影响

Influence of viral load on incidence of gestational diabetes mellitus of pregnant women with hepatitis B virus infection

目的探讨乙型肝炎病毒(HBV)感染孕妇病毒载量对妊娠期糖尿病(GDM)发病的影响。方法选取2010年1月-2015年12月医院产科住院分娩的慢性HBV携带产妇168例,根据HBV-DNA载量,92例<1×103拷贝/ml为HBV-DNA阴性组,76例≥1×103拷贝/ml为HBV-DNA阳性组,另外选取同期住院分娩的非HBV携带孕妇100例作为对照组,分娩前,采集孕妇清晨空腹血,采用荧光定量PCR进行HBV-DNA定量检测,孕24~28周,所有孕妇接受75g口服糖耐量实验,以患者妊娠末期为观察终点,检测空腹血糖(FBG)、餐后2h血糖(2hPG)、糖化血红蛋白(Hb A1c)。结果 168例慢性HBV携带产妇中HBV-DNA载量<1×103拷贝/ml者92例占54.8%,HBV-DNA载量≥1×103拷贝/ml者76例占45.2%,HBV-DNA阴性组和HBV-DNA阳性组妊娠期糖尿病发生率分别为18.5%和19.7%均显著高于对照组(P<0.05),HBV-DNA阴性组和HBV-DNA阳性组妊娠期糖尿病发生率比较差异无统计学意义;HBV-DNA阴性组和HBV-DNA阳性组FBG(6.95±0.35)mmol/L和(7.03±0.36)mmol/L、2hPG(10.25±1.28)mmol/L和(10.15±1.11)mmol/L和Hb A1c(8.65±0.96)%和(8.90±0.89)%水平均显著高于对照组的(4.56±0.33)mmol/L、(6.15±0.85)mmol/L和(5.12±0.56)%(P<0.05);HBV-DNA阴性组和HBV-DNA阳性组FBG、2hPG和Hb A1c水平比较差异无统计学意义;168例慢性HBV携带产妇HBV-DNA载量与FBG、2hPG和Hb A1c均存在明显正相关性(P<0.01)。结论HBV感染会增加孕妇妊娠期糖尿病的发生率,HBV-DNA载量与孕妇血糖水平存在明显相关性。

OBJECTIVE To explore the impact of viral load on incidence of gestational diabetes mellitus of pregnant women with hepatitis B virus（HBV）infection.METHODS A total of 168 HBV-positive pregnant women who were hospitalized the obstetrics department from Jan 2010 to Dec 2015 were enrolled in the study.According to the HBV-DNA load,92 pregnant women whose HBV-DNA load was less than 1＆#215;103copies/ml were assigned as the HBV-DNA negative group,76 pregnant women whose HBV-DNA load was no less than 1＆#215;103copies/ml was set as the HBV-DNA positive group,meanwhile,100 pregnant women who were negative for HBV and gave birth during the same period were chosen as the control group.The morning fasting blood was drawn from the pregnant women,the quantitative determination of HBV-DNA was carried out by means of fluorogenic quantitative PCR, all of the pregnant women received the 75g oral glucose tolerance test at gestational age of 24-28 weeks,and the fasting blood glucose（FBG）,2 h postprandial blood glucose（2 h PG）and glycosylated hemoglobin（Hb A1c） were measured at the end of gestation.RESULTS Of the 168 pregnant women who carried with chronic HBV,92 （54.8%）had the HBV-DNA less than 1＆#215;103copies/ml,76（45.2%）had the HBV-DNA no less than 1＆#215;103 copies/ml.The incidence of gestational diabetes mellitus was 18.5% in the HBV-DNA negative group,19.7% in the HBV-DNA positive group,significantly higher than that in the control group（P〈0.05）,and there was no significant difference in the incidence of gestational diabetes mellitus between the HBV-DNA positive group and the HBV-DNA negative group.The FBG level was（6.95 ± 0.35）mmol/L in the HBV-DNA negative group, （7.03 ± 0.36）mmol/L in the HBV-DNA positive group,significantly higher than（4.56 ± 0.33）mmol/L in the control group;the 2 h PG level was（10.25 ± 1.28）mmol/L in the HBV-DNA negative group,（10.15 ± 1.11） mmol/L in the HBV-DNA positive group,significantly higher than（6.15 ± 0.85）mmol/L in the control group;the Hb A1c level was（8.65 ± 0.96）% in the HBV-DNA negative group,（8.90 ± 0.89）in the HBV-DNA posi-tive group,significantly higher than（5.12 ± 0.56）% in the control group（P〈0.05）.There was no significant difference in the FBG,2 h PG or Hb A1c level between the HBV-DNA negative group and the HBV-DNA positive group.The HBV-DNA load of the 168 pregnant women who carried with chronic HBV showed significantly posi-tive correlation with the FBG,2 h PG and Hb A1c（P〈0.01）.CONCLUSION The HBV infection may lead to the increase of incidence of the gestational diabetes mellitus,and the HBV-DNA load is positively correlated with the blood glucose level of the pregnant women.