乙型肝炎病毒感染与不良妊娠结局之间的关联—系统评价和荟萃分析

Correlation between hepatitis B virus infection and adverse pregnancy outcomes—a systematic review and meta-analysis

目的:系统评价乙型肝炎病毒(HBV)感染对不良妊娠结局发生风险的影响。方法:检索PubMed、Embase、Web of science和Cochrane数据库。采用主题词和自由词相结合的方式,检索"Hepatitis B viruses"和"Pregnancy Outcomes"相关文献纳入研究。包括自数据库建立至2021年12月发表的临床研究文献。由2名研究者独立筛选文献、提取数据、质量评价,采用R 4.4.1软件进行meta分析和累积meta分析。使用固定/随机效应模型分析异质和非异质结果。通过亚组分析识别异质性调节因子。采用漏斗图和peters检验分析潜在的发表偏倚。结果:共纳入涉及92836例乙型肝炎表面抗原阳性孕妇和7123292例乙型肝炎表面抗原阴性孕妇的共48项研究。在不良孕妇结局方面,HBV感染与孕妇妊娠期糖尿病[比值比(OR)=1.34,95%置信区间(CI):1.17~1.53]和妊娠期肝内胆汁淤积症(OR=2.48,95%CI:1.88~3.29)的发生具有相关性,差异有统计学意义。在不良新生儿结局方面,HBV感染与新生儿窒息(OR=1.49,95%CI:1.20~1.86)和早产(OR=1.22,95%CI:1.12~1.33)的发生具有相关性,差异有统计学意义。另外,对HBV感染孕妇发生妊娠期糖尿病和早产的风险进行了累积荟萃风险分析,发现两者的发生风险分别于2009年及2010年后趋于稳定,再进行重复研究对补充回答问题的意义有限。结论:HBV感染可能增加孕妇发生妊娠期肝内胆汁淤积症、妊娠期糖尿病、新生儿窒息和早产的风险。

Objective To systematically evaluate the effect of hepatitis B virus(HBV)infection on the risk of adverse pregnancy outcomes.Methods We searched PubMed,Embase,Web of Science,and Cochrane databases.Two researchers independently screened the literature,extracted data,and evaluated the quality.Meta-analysis and cumulative meta-analysis were performed using R4.4.1 software.Fixed/random effects models were used to analyze heterogeneous and non-heterogeneous results.Heterogeneous modifiers were identified by subgroup analysis.Funnel plots and Peters'test were used to analyze potential publication bias.Results A total of 48 studies involving 92836 HBsAg-positive pregnant women and 7123292 HBsAg-negative pregnant women were included.In terms of adverse pregnancy outcomes,HBV infection was significantly correlated with the occurrence of gestational diabetes mellitus[odds ratio(OR)=1.34,95%confidence interval(CI):1.17-1.53]and intrahepatic cholestasis(OR=2.48,95%CI:1.88-3.29),with statistically significant differences.In terms of adverse neonatal outcomes,HBV infection was significantly correlated with the occurrence of neonatal asphyxia(OR=1.49,95%CI:1.20-1.86)and preterm birth(OR=1.22,95%CI:1.12-1.33),with statistically significant differences.In addition,the cumulative meta-analysis demonstrated that the risk of gestational diabetes mellitus and preterm birth both tended to be stable in pregnant women with HBV infection following 2009 and 2010,respectively.The supplementary questions answered for repeated studies had limited significance.Conclusion Intrahepatic cholestasis,gestational diabetes mellitus,neonatal asphyxia,and preterm birth occurrence risk can be raised with HBV infection in pregnant women.