慢性乙型病毒性肝炎患者妊娠10～14周药物流产效果评价

Clinical efficacy of medical abortion for terminated pregnant at 10-14 gestational weeks of women with chronic Hepatitis B

目的:评价妊娠10~14孕周合并慢性乙型肝炎妇女进行药物流产的安全性及有效性。方法:回顾性分析2013年1月—2017年12月妊娠10~14周,转氨酶(ALT)升高2~10倍正常值上限(ULN),经抗病毒保肝治疗ALT降至≤2ULN,自愿选择米非司酮配伍米索前列醇终止妊娠乙肝病毒(HBV)感染者为观察组(40例),选择同期药物流产ALT正常的HBV感染者作为对照组(80例),比较两组流产成功率、药物不良反应,以及对肝功能的影响。结果:两组对象年龄、孕次、产次、孕周、凝血酶原活动度PTA无统计学差异,观察组E抗原阳性率、HBV-DNA值、初诊时ALT水平高于对照组。两组流产成功率无统计学意义(P>0.05)。观察组流产后ALT异常比率(40%)高于对照组(2.5%)(P<0.05),继续给予保肝治疗后均恢复正常。两组其它不良反应的发生率无明显差异。初诊时ALT≥3ULN者,流产后肝功能异常(ALT升高2ULN以上)比率[55.6%(10/18)]与对照组[27.3%(6/22)]无差异(P>0.05)。结论:米非司酮配伍米索前列醇终止慢性乙型肝炎伴ALT异常者10~14周妊娠相对安全有效,但应严密评估高危因素,积极保肝、抗病毒治疗,严密监测肝功能变化。对于ALT>3倍ULN者建议慎重选择流产方式。

Objective：To assess the efficacy and safety of medical abortion for terminated pregnant at 10-14 gestational weeks of women with chronic Hepatitis B.Methods：A retrospective study was conducted.From January 2013 to December 2017,40 pregnant women with chronic Hepatitis B at 10-14 gestational weeks in Beijing You＇an hospital of capital medical university were included in observation group,whose transaminase（ALT）level had elevated ranging from 2-10 ULN,and when their ALT level decreased to≤2 ULN after given antiviral and liver protection treatment,these women had experienced medical abortion by mifepristone combined with misoprostol voluntarily.At the same period,another 80 pregnant women with chronic Hepatitis B were selected into control group,whose ALT level were normal,and they also had experienced medical abortion by mifepristone combined with misoprostol voluntarily.The ratio of complete abortion,the change of ALT after abortion and the incidence of adverse events were compared between the two groups.Results：There was no statistical significant difference in the age of women,the frequency of gravida and para of women,gestational weeks,and PTA between the two groups.The positive rate of E antigen,amount of HBV-DNA load and ALT level of women at the first visited hospital in observation group were significant higher than those of women in control group.The success rate of abortion had no significant difference between the two groups（P〉0.05）.After abortion,the rate of abnormal ALT level of women in observation group（40%）were significant higher than that（2.5%）of women in control group（P〈0.05）,and all women with abnormal ALT had recovered health after treatment continually.There was no significant difference in other incidence of adverse events between the two groups.55.6%（10/18）women with ALT value equal to or over 3 ULN when the first visited hospital in observation group had ALT value over 2 ULN after abortion,which was higher than that of women with ALT value less than 3 ULN（27.3%,6/22）,but there was no significant difference（P〉0.05）.Conclusion：Mifepristone combined with misoprostol for terminated pregnant at 10-14 gestational weeks of women with chronic Hepatitis B is safe and effective,however,the high risk factors should be evaluated before abortion,and pregnant women with chronic Hepatitis B and ALT level elevated should be given treatment of liver protection and antiviral.Pregnant women with ALT value equal to or over 3 ULN should select artificial abortion method cautiously.