乙型肝炎肝硬化合并妊娠对妊娠并发症及新生儿结局的影响

Influence of hepatitis B related liver cirrhosis on pregnancy complications and neonatal outcomes

目的探讨乙型肝炎肝硬化对妊娠并发症及新生儿结局的影响。方法收集2008年12月至2020年12月于首都医科大学附属北京地坛医院分娩的55例乙型肝炎肝硬化孕产妇的病例资料(研究组);同时选取与研究组年龄和孕周相匹配的55例慢性乙型肝炎孕产妇为对照组。回顾性分析两组孕产妇白细胞(WBC)、血红蛋白(Hb)、红细胞(RBC)、丙氨酸氨基转移酶(ALT)、天门冬氨酸转移酶(AST)、总胆红素(TBil)、凝血酶原时间(PT)及血小板(PLT)计数等资料;采用卡方检验比较研究组与对照组妊娠并发症以及新生儿不良结局。结果终止妊娠前,对照组与研究组孕产妇WBC计数[7.95(6.12,9.17)×10^(9)/L vs.6.88(5.66,8.05)×10^(9)/L,Z=-1.674、P=0.095]、ALT[20.10(13.00,36.70)U/L vs.17.5(13.30,21.20)U/L,Z=-1.698、P=0.090]和AST[25.70(16.30,35.10)U/L vs.25.40(20.80,31.50)U/L,Z=-1.034、P=0.303]差异均无统计学意义;而两组孕产妇Hb[120.00(110.00,128.00)g/L vs.111.00(96.60,119.00)g/L,Z=-3.696、P<0.001]、RBC计数[3.93(3.57,4.16)×10^(9)/L vs.3.34(2.97,3.71)×10^(9)/L,Z=-5.055、P<0.001]、TBil[7.5(5.80,9.80)μmol/L vs.10.00(7.30,14.10)μmol/L,Z=-2.816、P=0.005]、PT[10.40(10.00,11.10)s vs.11.50(10.60,12.90)s,Z=-4.023、P<0.001]及PLT计数[172.00(142.40,211.00)×10^(9)/L vs.79.2(60.80,140.20)×10^(9)/L,Z=-6.068、P<0.001]差异均有统计学意义。对照组与研究组孕妇妊娠并发症(妊娠期糖尿病、妊娠期高血压疾病、甲状腺功能异常、羊水异常、胎膜早破、肝功能异常、胆红素异常及妊娠肝内胆汁淤积症)差异均无统计学意义(P均>0.05);而两组产后出血[4例(7.27%)vs.14例(25.45%),χ^(2)=6.643、P=0.010]、妊娠合并贫血[10例(18.18%)vs.27例(49.09%),χ^(2)=11.770、P=0.001]、凝血功能障碍[3例(5.45%)vs.10例(18.18%);χ^(2)=4.274、P=0.039]及剖宫产[29例(52.73%)vs.46例(83.64%);χ^(2)=12.110、P=0.001]发生率差异均有显著统计学意义。两组新生儿窒息[2例(3.64%)vs.3例(5.45%),χ^(2)=0.000、P=1.000]、死亡[0例(0.00%)vs.2例(3.64%),χ^(2)=0.509、P=0.405]以及胎儿畸形[1例(1.82%)vs.0例(0.00%),P=1.000)发生率差异均无显著统计学意义。结论乙型肝炎肝硬化孕产妇较慢性乙型肝炎孕产妇发生产后出血、贫血及凝血功能障碍的风险更高,剖宫产率亦升高,应于妊娠期严密监测乙型肝炎肝硬化孕产妇的病情变化。

Objective To investigate the influence of hepatitis B related liver cirrhosis on pregnancy complications and neonatal outcomes.Methods Clinical data of 55 pregnant women with hepatitis B related liver cirrhosis(research group)who delivered in Beijing Ditan Hospital,Capital Medical University from December 2008 to December 2020 were collected,while patients with chronic hepatitis B were collected as control group(55 cases)with matched age and gestational weeks.The differences of white blood cells(WBC)count,hemoglobin(Hb),red blood cell(RBC)count,alpionine aminotransferase(ALT),apartate acid transferase(AST),total bilirubin(TBil),prothrombin time(PT)and platelet(PLT)count between the two groups were analyzed,retrospectively.Pregnancy complications and neonatal adverse outcomes of the two groups were analyzed by chi-square test.Results The levels of WBC count[7.95(6.12,9.17)×10^(9)/L vs.6.88(5.66,8.05)×10^(9)/L;Z=-1.674,P=0.095],ALT[20.10(13.00,36.70)U/L vs.17.5(13.30,21.20)U/L;Z=-1.698,P=0.090]and AST[25.70(16.30,35.10)U/L vs.25.40(20.80,31.50)U/L;Z=-1.034,P=0.303]of cases in control group and research group before pregnancy termination were all without significant differences.However,the levels of hemoglobin[120.00(110.00,128.00)g/L vs.111.00(96.60,119.00)g/L;Z=-3.696,P<0.001],RBC count[3.93(3.57,4.16)×10^(9)/L vs.3.34(2.97,3.71)×10^(9)/L;Z=-5.055,P<0.001],TBil[7.5(5.80,9.80)μmol/L vs.10.00(7.30,14.10)μmol/L;Z=-2.816,P=0.005],PT[10.40(10.00,11.10)s vs.11.50(10.60,12.90)s;Z=-4.023,P<0.001]and PLT count[172.00(142.40,211.00)×10^(9)/L vs.79.2(60.80,140.20)×10^(9)/L;Z=-6.068,P<0.001]between cases of the two groups were all with significant differences.The rates of pregnancy complications including gestational diabetes mellitus,gestational hypertension disease,thyroid dysfunction,amniotic fluid abnormality,premature rupture of membrane,liver function abnormality,bilirubin abnormality and intrahepatic cholestasis of pregnancy between cases of the two groups were all without significant differences(all P>0.05).However,the incidence rates of postpartum hemorrhage[4 cases(7.27%)vs.14 cases(25.45%);χ^(2)=6.643,P=0.010],anemia associated with pregnancy[10 cases(18.18%)vs.27 cases(49.09%);χ^(2)=11.770,P=0.001],coagulation dysfunction[3 cases(5.45%)vs.10 cases(18.18%);χ^(2)=4.274,P=0.039]and cesarean section[29 cases(52.73%)vs.46 cases(83.64%);χ^(2)=12.110,P=0.001]were all with significant differences(all P<0.05).The rates of adverse pregnancy outcomes including neonatal asphyxia[2 cases(3.64%)vs.3 cases(5.45%);χ^(2)=0.000,P=1.000],neonatal death[0 case(0.00%)vs.2 cases(3.64%);χ^(2)=0.509,P=0.405]and fetal malformation[1 case(1.82%)vs.0 case(0.00%),P=1.000]between newborns of the two groups were all without significant differences(all P>0.05).Conclusions Pregnant women with hepatitis B related liver cirrhosis were at higher risk of postpartum hemorrhage,anemia and coagulation dysfunction than pregnant women with chronic hepatitis B,and the rates of cesarean section also increased.Therefore,the condition changes of pregnant women with hepatitis B related liver cirrhosis should be closely monitored during pregnancy.