慢性乙型肝炎孕产妇肝功能指标和病毒载量对不良妊娠结局的影响

摘要/Abstract

摘要： 目的探讨慢性乙型肝炎(CHB)孕产妇肝功能指标和HBV DNA对不良妊娠结局的影响。方法纳入2019年1月至2022年12月海安市人民医院妇产科收治的CHB孕产妇156例,其中ALT≥160 U/L 19例,ALT＜160 U/L 137例;TBil≥17.1 μmol/L 13例,TBil＜17.1 μmol/L 143例;HBV DNA≥1×10⁶拷贝/mL 52例,HBV DNA＜1×10⁶拷贝/mL 104例。选择同期住院分娩的健康孕产妇70名作为对照组。CHB组均给予富马酸丙酚替诺福韦片口服治疗,直至分娩;孕妇采用人乙型肝炎免疫球蛋白(HBIG)阻断治疗,新生儿采用HBIG和乙肝疫苗阻断治疗。比较两组的基线资料和血清学指标,CHB组不同血清学指标患者的不良妊娠结局发生率,logistic回归分析CHB孕产妇不良妊娠结局的影响因素。结果 CHB组的妊娠糖尿病(GDM)、妊娠肝内胆汁淤积(ICP)、先兆子痫(PE)、胎膜早破(PROM)、羊水粪染、新生儿窒息、产后出血、新生儿高胆红素血症(HNB)发生率为27.56%、5.77%、12.18%、19.51%、11.54%、8.97%、17.95%、10.90%,HbA1c水平为(6.02±0.78)%,高于对照组的5.71%、2.86%、4.29%、7.14%、4.29%、2.86%、4.29%、2.86%、(5.49±0.71)%,差异有统计学意义(χ²=3.764、2.845、3.159、2.780、3.086、3.264、3.347、3.026,t=5.218,均P<0.05)。CHB组的ALT、TBil水平和HBV DNA为(93.24±7.36)U/L、(22.59±3.18)μmol/L、(1.26±0.34)×10⁶拷贝/mL,高于对照组的(27.56±4.81)U/L、(14.82±2.05)μmol/L、0,差异有统计学意义(t=9.524、27.275、11.793,P<0.001)。CHB孕产妇中,ALT≥160 U/L组的PROM、新生儿窒息、产后出血和HNB发生率为36.84%、15.79%、42.11%、31.58%,高于ALT＜160 U/L组的11.68%、8.03%、14.60%、8.03%,差异有统计学意义(χ²=4.651、3.291、4.425、5.047,均P<0.05);TBil≥17.1 μmol/L组的羊水粪染、新生儿窒息、产后出血和HNB发生率为30.77%、23.08%、53.85%、38.46%,高于TBil＜17.1 μmol/L组的9.79%、7.69%、14.69%、8.39%,差异有统计学意义(χ²=4.862、4.375、4.809、5.286,均P<0.05);HBV DNA≥1×10⁶拷贝/mL组的PROM、羊水粪染、新生儿窒息、产后出血和HNB发生率为25.00%、19.23%、15.38%、28.85%、19.23%,高于HBV DNA＜1×10⁶拷贝/mL组的9.62%、7.69%、5.77%、12.50%、6.73%,差异有统计学意义(χ²=3.548、3.472、3.718、3.297、4.186,均P<0.05)。logistic回归分析显示,ALT≥160 U/L、TBil≥17.1 μmol/L和HBV DNA≥1×10⁶拷贝/mL为CHB孕产妇不良妊娠结局的影响因素(P<0.05)。结论 CHB孕产妇血清ALT、TBil水平和HBV DNA越高,不良妊娠结局发生率越高,可为围生期管理提供参考依据。

关键词: 孕产妇, 慢性乙型肝炎, 肝功能, 病毒载量, 不良妊娠结局

Abstract: Objective To explore the effects of liver function index and HBV DNA load on adverse pregnancy outcome in pregnant women with chronic hepatitis B (CHB), and to provide reference for perinatal management. Methods A total of 156 pregnant women with CHB admitted to the obstetrics and gynecology department of Haian People's Hospital from January 2019 to December 2022 were included in the study group. According to the serum alanine aminotransferase (ALT) level, they were divided into ALT ≥ 160 U/L group and ALT < 160 U/L group. They were divided into high total bilirubin (TBil) group ( ≥ 17.1 μmol/L) and normal TBil group ( < 17.1 μmol/L). According to HBV DNA load, they were divided into high HBV DNA load group ( ≥ 1×10⁶ copies/mL) and low HBV DNA load group (< 1×10⁶ copies/mL). 70 healthy pregnant women who gave birth in hospital during the same period were included in the control group. All the study groups were given oral treatment of Pofol tenofovir fumarate until delivery. Pregnant women were treated with human hepatitis B immunoglobulin (HBIG) blocking therapy, and newborns were treated with HBIG and hepatitis B vaccine blocking therapy. The baseline data and serological indicators of the two groups were detected and compared, the incidence of adverse pregnancy outcomes in each subgroup was compared, and the influencing factors of adverse pregnancy outcomes in CHB pregnant women were analyzed by logistic regression. Results In the study group, the incidence rates of gestational diabetes mellitus (GDM), intrahepatic cholestasis of pregnancy (ICP), preeclampsia (PE), premature rupture of membranes (PROM), fecal amniotic fluid, neonatal asphyxia, postpartum hemorrhage, neonatal hyperbilirubinemia (HNB) were 27.56%, 5.77%, 12.18%, 19.51%, 11.54%, 8.97%, 17.95%, 10.90%. HbA1c level was 6.02±0.78% in the study group, which was higher than 5.71%, 2.86%, 4.29%, 7.14%, 4.29%, 2.86%, 5.49±0.71%, 4.29%, 2.86%, 5.49±0.71% in control group. The difference was statistically significant (t/χ²=3.764, 2.845, 3.159, 2.780, 3.086, 3.264, 3.347, 3.026, 5.218, all P<0.05). The levels of ALT, TBil, and HBV DNA load in the study group were 93.24±7.36U/L, 22.59±3.18 μmol/L, 1.26±0.34×10⁶ copies/mL, respectively, which were higher than those in the control groups (27.56±4.81 U/L, 14.82±2.05 μmol/L, 0×10⁶ copies/mL) with the statistically significant difference (t=9.524, 2.7.275, 11.793, P<0.001). In CHB pregnant women, the incidence rates of PROM, neonatal asphyxia, postpartum hemorrhage and HNB in ALT≥160 U/L group were 36.84%, 15.79%, 42.11% and 31.58%, which were higher than those in ALT < 160 U/L group (11.68%, 8.03%, 14.60% and 8.03%). The difference was statistically significant (χ²=4.651, 3.291, 4.425, 5.047, all P<0.05). The incidence rates of fecal amniotic fluid contamination, neonatal asphyxia, postpartum hemorrhage and HNB in the high TBil group were 30.77%, 23.08%, 53.85% and 38.46%, which were higher than those in the normal TBil group (9.79%, 7.69%, 14.69% and 8.39%). The difference was statistically significant (χ²=4.862, 4.375, 4.809, 5.286, all P<0.05). The incidence rates of PROM, fecal amniotic fluid staining, neonatal asphyxia, postpartum hemorrhage and HNB in the high-load group were 25.00%, 19.23%, 15.38%, 28.85%, 19.23%, higher than those in the low-load group (9.62%, 7.69%, 5.77%, 12.50%, 6.73%). The difference was statistically significant (χ²=3.548, 3.472, 3.718, 3.297, 4.186, all P<0.05). logistic regression analysis showed that ALT≥160 U/L, TBil≥17.1 μmol/L and HBV DNA≥1×10⁶ copies/mL were the influential factors for adverse pregnancy outcomes in CHB pregnant women (P<0.05). Conclusion The higher the serum ALT, TBil and HBV DNA load of CHB pregnant women, the higher the incidence of adverse pregnancy outcomes, which can provide reference for perinatal management.

Key words: Pregnant women, CHB, Liver function, Viral load, Adverse pregnancy outcome

朱艳梅, 孙冬梅, 徐晓英. 慢性乙型肝炎孕产妇肝功能指标和病毒载量对不良妊娠结局的影响[J]. 肝脏, 2025, 30(4): 495-499.

ZHU Yan-mei, SUN Dong-mei, XU Xiao-ying. Effects of liver function indexes and viral load on adverse pregnancy outcomes in pregnant women with chronic hepatitis B[J]. Chinese Hepatolgy, 2025, 30(4): 495-499.

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