419例妊娠合并乙型肝炎病毒感染患者不同病毒载量对母-婴结局的影响

Influence on Different Viral Load Categories of Outcomes of Maternal and Neonatal in 419 Pregnant Patients with HBV infection

目的:探究妊娠合并乙型肝炎病毒(HBV)感染患者不同病毒载量对母-婴结局的影响。方法:选取2013年3月—2014年9月期间收治住院分娩的合并HBV感染孕妇419例临床资料,按HBV-DNA病毒载量的高低将其分成3组,即HBV-DNA≥1×10~6U/m L的165例为高病毒载量组;HBV-DNA≤5.0×10~2U/m L的119例为低病毒载量组;HBV-DNA介于5.0×10~2U/m L和1×10~6U/m L之间的135例为中病毒载量组;采用回顾性分析,比较各组孕妇在妊娠并发症(早产、产后出血、胎儿窘迫、妊娠期高血压病、胎膜早破)及新生儿出生体质量、新生儿窒息、新生儿出生缺陷等方面的差异。结果:HBV-DNA≥1×10~6U/m L的高病毒载量组在早产、产后出血、妊娠期高血压病、胎膜早破的发生率高于中、低病毒载量组(P<0.05);胎儿窘迫、新生儿出生体质量、新生儿出生缺陷等方面各组间经比较其差异无统计学意义(P>0.05)。结论:妊娠合并HBV感染对母-婴结局易造成不良影响,尤其高病毒载量对母-婴的危害较大,因此,要重视产前检查和围生期监测,以改善母-婴结局。

Objective： To investigate the influence of different viral load categories on outcomes of maternal and neonatal in 419 pregnant patients with HBV infection. Methods： Selecting 419 pregnant women with HBV infection from March 2013 to September 2014 tand their clinical data were analyzed. They were divided into 3 groups according to the load of HBV-DNA virus of patient, as follows： high viral load group（165 cases, HBV-DNA≥1×10~6 U/m L）; low viral load group（119 cases, HBV-DNA≤5.0×10~2 U/m L; and medium viral load group（135 cased, HBV-DNA were between the range of 5.0×10~2 U/m L and 1×10~6 U/m L. Retrospective analysis was used, the differences of three groups differences on maternal with the pregnancy complications（preterm birth, postpartum hemorrhage, fetal distress and pregnancy induced hypertension, premature rupture of membranes） and neonatal with birth weight, neonatal asphyxia, birth defects, and so on were compared. Results： The incidence of preterm birth, postpartum hemorrhage, pregnancy induced hypertension and premature rupture of membranes in high viral load group（HBV-DNA1×10~6 U/m L） was higher than that ones in low viral load group and medium viral load group; the differences were statistically significant（P〈0.05）.There was no difference in fetal distress, neonatal birth weight and birth defects among three groups and the difference was not statistically significant（P〉0.05）. Conclusion： Pregnancy with HBV can cause adverse effects on the outcomes of maternal and neonatal, especially high viral load is harmful to maternal and neonatal. Therefore, antenatal examination and perinatal monitoring should be emphasized so as to improve the outcome of maternal and neonatal.