HBV感染对慢性HCV感染孕妇围生期的影响

Influence of HBV infection on perinatal period of pregnant women with chronic HCV infection

目的探讨HBV感染对慢性HCV感染孕妇妊娠结局的影响。方法对北京地坛医院妇产科2012年1月至2018年12月收治的HCV感染孕妇检测乙肝五项,其中乙型肝炎病毒表面抗原(HBsAg)阳性52例为双重感染组,HBsAg阴性84例为单一感染组,比较两组孕妇孕早期及孕晚期肝功能及妊娠结局。结果两组患者孕早期ALT、AST、TBIL、TBA比较均无显著性差异(P=0.882、0.135、0.354、0.525),两组HCV-RNA水平也无统计学差异(P=0.315)。两组孕晚期ALT、AST虽有增高趋势,但差异均无统计学意义(P=0.149、0.512),两组孕晚期TBIL、TBA比较无统计学差异(P=0.779、0.666)。双重感染组PROM的发生率(21.1%)较对照组(8.33%)差异有统计学意义(P<0.001),PPH发生率较对照组高(40.6%vs 14.9%),有显著性差异(P=0.032),两组早产、ICP、GDM、HDP发生率均无统计学差异。结论妊娠期乙型、丙型肝炎病毒双重感染可能增加胎膜早破的发生率,应加强孕期保健及监测。产后出血的发生率增高,对乙型、丙型肝炎病毒双重感染的产妇积极预防产后出血的发生更为重要。

Objective To investigate the effect of HBV infection on pregnant women with chronic HCV infection.Methods 5 markers of hepatitis B were detected in Pregnant women with chronic HCV infection, who were treated in Beijing Ditan Hospital of Capital Medical University from January 2012 to December 2018. The patients were divided into 2 groups,HBV/HCV co-infected group(n=52) and simply HCV infected group(n=84). The liver function and pregnancy outcome of the two groups were compared. Results There was no significant difference in ALT, AST, TBIL and TBA between the two groups in early pregnancy(P=0.882, 0.135, 0.354, 0.525). ALT and AST increased in the third trimester of pregnancy, the difference was not statistically significant(P=0.149, 0.512). There was no significant difference in the levels of TBIL(P=0.779) and TBA(P=0.666) between the two groups in the third trimester of pregnancy. The incidence of PROM and PPH in the dual infection group(21.1% vs 40.6%) was significantly different than in the control group(8.33% vs 14.9%)(P<0.001, P=0.032). There was no statistical difference in the incidence of preterm birth, ICP, GDM, and HDP between the two groups. Conclusion Double infection of hepatitis B and C viruses may increase the incidence of premature rupture of membranes, and health care and monitoring during pregnancy should be strengthened. It is even more important to actively prevent the occurrence of postpartum hemorrhage for pregnant women with double infection of hepatitis B and C viruses.