母体孕期乙型肝炎病毒感染与早产关联队列研究

Maternal hepatitis B virus infection and preterm delivery:a retrospective cohort study

目的研究母体乙型肝炎病毒(HBV)感染与早产的关联。方法将2011年1月—2014年12月期间在安徽医科大学第一附属医院分娩的12186对母亲-单胎配对资料纳入本次研究,回顾性分析母体孕期HBV感染与早产的关联。结果该队列人群包括对照11550例(94.78%),HBV感染乙肝e抗原阴性者[HBeAg(-)]362例(2.97%)和HBeAg(+)者274例(2.25%)。母体HBV感染组平均孕周低于对照组,其中HBeAg(+)组平均孕周最低。HBV感染HBeAg(-)组早产儿发生率为17.13%,与对照组相比差异无统计学意义。HBV感染HBeAg(+)组早产儿发生率为24.09%,显著高于对照组的14.66%(调整RR=1.75,95%CI=1.29~2.38)。进一步分析发现,HBV感染HBeAg(-)组早期早产发生率为4.14%,显著高于对照组的2.60%(调整RR=1.93,95%CI=1.02~3.65);HBV感染HBeAg(+)组晚期早产发生率为19.35%,显著高于对照组的11.97%(调整RR=1.74,95%CI=1.25~2.41),HBV感染HBeAg(+)组早期早产发生率为4.74%,也显著高于对照组(调整RR=2.04,95%CI=1.17~3.56)。结论HBV感染HBeAg(-)是早期早产危险因素,HBV感染HBeAg(+)不仅增加早期早产而且增加晚期早产发生风险。

Objective To investigate the association between maternal hepatitis B virus(HBV)infection and the risk of preterm delivery in a birth cohort study.Methods We collected the data on 12186 mother-singleton infant pairs registered at First Affiliated Hospital of Anhui Medical University between January 2011 and December 2014 for a retrospective cohort study on the association between maternal HBV infection and preterm delivery.The puerperae of the cohort were grouped into cases(serum HBV surface antigen positive[HBsAg+])and controls(HBsAg negative[HBsAg-])based on the results of enzyme-linked immunosorbent assay.Results Of all the puerpaerae studied,94.78% were controls;2.97%were the cases being HBV e antigen negative(HBeAg-)and 2.25% were cases being HBeAg positive(HBeAg+).The mean gestational age of the cases was lower than that of the controls and the mean gestational age was the lowest in the HBeAg+ cases.The incidence rate of preterm delivery was 17.13%in the HBeAg-cases and was not significantly differ from that of the controls;but in the HBeAg+cases,the incidence rate was 24.09% and significantly higher than that(14.66%)in the controls,with an adjusted relative risk[adj RR]of 1.75(95%confidence interval[95%CI]:1.25-2.41).Compared to the controls,the HBeAg-cases had a significantly increased incidence of early preterm delivery(4.14%vs 2.60%,adj RR=1.93[95%CI:1.02-3.65]);in comparison with the controls,the HBeAg+cases had a significantly higher incidence of late preterm delivery(19.35%vs.11.97%,adj RR=1.74[95%CI:1.36-2.59])and also a significantly higher incidence of early preterm delivery(4.74%vs.2.69%,adj RR=2.04[95%CI:1.17-3.56]).Conclusion Maternal HBV infection with negative serum HBeAg is associated with an increased risk of early preterm delivery;maternal HBV infection with positive serum HBeAg increases both the risk of early and late preterm delivery.