分娩前丙氨酸氨基转移酶水平预测慢性乙型肝炎病毒感染孕妇产后肝功能价值分析

Value of alanine aminotransferase levels before delivery in predicting postpartum liver function in pregnant women with chronic hepatitis B virus infection

目的探讨分娩前丙氨酸氨基转移酶(ALT)水平预测慢性乙型肝炎病毒(HBV)感染孕妇产后肝功能的价值。方法选取2017年10月~2019年10月于淮安市妇幼保健院分娩的孕产妇150例,均于分娩前确诊为慢性乙型肝炎。于分娩前1 d和分娩后检测外周血ALT水平。根据是否存在分娩后肝功能异常将产妇分为肝功能异常组和肝功能正常组。分析两组患者基础生化资料以及分娩后肝功能异常的独立影响因素,使用ROC曲线评估ALT水平预测分娩后肝功能异常的价值。结果分娩后肝功能异常30例,肝功能异常组分娩前ALT、谷草转氨酶(AST)水平、孕期饮酒史高于肝功能正常组,差异有统计学意义(P<0.05)。两组间年龄、慢性乙型肝炎病程、体质量指数、孕周、乙型肝炎病毒DNA、分娩前收缩压、分娩前舒张压、乙肝病毒阳性率、孕期吸烟史、流产史、剖宫产率、单胎妊娠比例、早产率、产次、慢性乙型肝炎病毒感染口服药物情况差异无统计学意义(P>0.05)。ROC曲线下面积为0.76,当ALT水平为41.0 U/L时,ALT诊断分娩后肝功能异常的灵敏度为62.2%,特异度为80.2%。多因素分析显示,ALT(P=0.002,OR:2.552,95%CI:1.302~11.357)、饮酒史(P=0.040,OR:1.226,95%CI:1.069~3.157)是分娩后肝功能异常的独立影响因素。结论分娩前ALT水平可预测分娩后慢性乙型肝炎孕妇产后肝功能异常,分娩前ALT水平升高产妇肝功能异常风险增加2.552倍。

Objective To investigate the value of alanine aminotransferase(ALT) before delivery in predicting postpartum liver function in pregnant women with chronic hepatitis B virus(HBV) infection. Methods A total of 150 pregnant women who delivered at Huai’an Maternal and Child Health Hospital from October 2017 to October 2019 were selected. All were diagnosed with chronic hepatitis B before delivery. ALT levels were measured 1 day before and after delivery. According to the presence of liver dysfunction after delivery, women were divided into liver dysfunction group and normal liver function group. The basic biochemical data of the two groups of patients and the independent influencing factors of liver dysfunction after childbirth were analyzed, and ROC curve was used to evaluate the value of ALT level in predicting liver dysfunction after childbirth. Results Thirty patients with abnormal liver function after delivery. The abnormal liver function components had higher levels of ALT, aspartate aminotransferase(AST), and drinking history during pregnancy than those with normal liver function, the differences were statistically significant(P<0.05). There was no significant difference in age, chronic hepatitis B course, body mass index, gestational week, hepatitis B virus DNA, systolic blood pressure before delivery, diastolic blood pressure before delivery, HBV positive rate, smoking history during pregnancy, abortion history, cesarean section rate, the ratio of single pregnancy, premature delivery, parity, and chronic oral hepatitis B virus infection between the two groups(P>0.05). The area under the ROC curve was 0.76. When the ALT level was 41.0 U/L, the sensitivity of ALT to diagnose liver abnormalities after delivery was 62.2% and the specificity was 80.2%. Multivariate analysis showed that ALT(P=0.002, OR: 2.552, 95%CI: 1.302~11.357) and drinking history(P=0.040, OR: 1.226, 95%CI: 1.069~3.157) were independent factors of abnormal liver function after delivery. Conclusion Prenatal ALT levels can predict postpartum liver function abnormalities in pregnant women with chronic hepatitis B after delivery, and increased prenatal ALT levels increase the risk of maternal liver function abnormalities by 2.552 times.