妊娠期糖尿病合并乙肝表面抗原阳性孕妇妊娠结局影响因素分析及对新生儿HBV感染的影响

Analysis of influencing factors on pregnancy outcome of pregnant women with gestational diabetes mellitus complicated with HBsAg positive and the influence on neonatal HBV infection

目的探讨妊娠期糖尿病(GDM)合并乙肝表面抗原(HBsAg)阳性孕妇的妊娠结局影响因素及对新生儿乙型肝炎病毒(HBV)感染的影响。方法选取2020年3月—2022年3月在温州市中心医院就诊的60例GDM合并HBsAg阳性孕妇为观察组,同期选取60例单纯GDM孕妇作为对照组。比较两组孕妇临床信息、肝功能指标以及不良妊娠结局的发生情况,采用logistic回归模型分析GDM合并HBsAg阳性孕妇妊娠结局的影响因素。结果观察组孕妇丙氨酸转氨酶(ALT)[(16.13±3.52)U/L vs.(11.48±2.71)U/L]、天门冬氨酸转氨酶(AST)[(23.27±7.03)U/L vs.(17.36±5.42)U/L]、总胆红素[(8.80±2.09)μmol/L vs.(7.23±1.71)μmol/L]、总胆汁酸[(4.07±1.53)μmol/L vs.(2.38±0.94)μmol/L]水平均显著高于对照组,差异均有统计学意义(均P<0.05)。观察组孕妇不良妊娠结局总发生率为60.0%,高于对照组的38.3%,差异有统计学意义(P<0.05)。logistic回归分析结果显示,年龄≥35岁(OR=2.015,95%CI:1.264~5.872)、ALT升高(OR=4.316,95%CI:2.326~9.714)、AST升高(OR=4.998,95%CI:2.649~11.347)、总胆汁酸升高(OR=2.235,95%CI:1.307~5.133)、HBsAg阳性(OR=6.340,95%CI:3.209~15.479)是导致不良妊娠结局的独立危险因素(P<0.05)。观察组新生儿HBsAg阳性率(20.0%vs.0)、HBV感染率(11.7%vs.0)均显著高于对照组,差异有统计学意义(P<0.05)。结论GDM孕妇合并HBsAg阳性可增加不良妊娠结局的发生风险和新生儿HBV感染率,高龄、肝功能异常及HBsAg阳性是导致不良妊娠结局的影响因素。

Objective To explore the influencing factors of pregnancy outcome of pregnant women with gestational diabetes mellitus(GDM)complicated with hepatitis B surface antigen(HBsAg)positive and the influence on neonatal hepatitis B virus(HBV)infection.Methods From March 2020 to March 2022,60 pregnant women with CDM and HBsAg positive were selected as the observation group,and 60 pregnant women with CDM alone were selected as the control group at the same time.The clinical information,liver function indexes and adverse pregnancy outcomes of the two groups of pregnant women were compared.logistic regression model was used to analyze the influencing factors of pregnancy outcomes of CDM complicated with HBsAg positive pregnant women.Results The levels of ALT[(16.13±3.52)U/L vs.(11.48±2.71)U/L],AST[(23.27±7.03)U/L vs.(17.36±5.42)U/L],total bilirubin[(8.80±2.09)μmol/L vs.(7.23±1.71)μmol/L]and total bile acid[(4.07±1.53)μmol/L vs.(2.38±0.94)μmol/L]in the observation group were significantly higher than those in the control group(P<0.05).The total incidence of adverse pregnancy outcomes in the observation group was 60.0%,higher than 38.3%in the control group(P<0.05).logistic regression analysis showed that age≥35 years(OR=2.015,95%CI:1.264-5.872),elevated ALT(0R=4.316,95%CI:2.326-9.714),elevated AST(0R=4.998,95%CI:2.649-11.347),elevated total bile acid(0R=2.235,95%CI:1.307-5.133),positive HBsAg(0R=6.340,95%CI:3.209-15.479)were independent risk factors for adverse pregnancy outcomes(P<0.05).The HBsAg positive rate(20.0%us.0)and HBV infection rate(11.7%vs.0)of neonates in the observation group were significantly higher than those in the control group(P<0.05).Conclusion GDM pregnant women with HBsAg positive can increase the risk of adverse pregnancy outcomes and the rate of neonatal HBV infection.The elderly,abnormal liver function,and HBsAg positive are the influencing factors leading to adverse pregnancy outcomes.