妊娠期肝内胆汁淤积症中无症状HBV感染的发生情况及妊娠结局的影响

肝脏 ›› 2024, Vol. 29 ›› Issue (12): 1558-1560.

妊娠期肝内胆汁淤积症中无症状HBV感染的发生情况及妊娠结局的影响

钱二艳, 龚咪, 王莉娟, 刘瑜

223001 江苏淮安市第四人民医院妇产科(钱二艳); 223300 南京医科大学附属淮安第一医院妇产科(龚咪); 223001 淮安市第四人民医院检验科(王莉娟); 223003 淮安市妇幼保健院产科(刘瑜)

收稿日期:2024-07-24 出版日期:2024-12-31 发布日期:2025-02-19
通讯作者: 刘瑜,Email:mermaid30@163.com
基金资助:
江苏省准安市科研计划项目(HAB201944)

Prevalence of asymptomatic hepatitis B virus infection in intrahepatic cholestasis of Pregnancy and its impact on pregnancy outcome

QIAN Er-yan¹, GONG Mi², WANG Li-juan³, LIU Yu⁴

1. Department of Obstetrics and Gynecology,Huai'an Fourth People's Hospital, Jiangsu 223001, China;
2. Department of Obstetrics and Gynecology,Huai'an First Hospital Affiliated to Nanjing Medical University,Jiangsu 223300, China;
3. Department of Laboratory Medicine, Huai'an Fourth People's Hospital, Jiangsu 223001, China;
4. Obstetrics and Gynecology Department of Huai'an Maternal and Child Health Hospital, Jiangsu 223003, China

Received:2024-07-24 Online:2024-12-31 Published:2025-02-19
Contact: LIU Yu,Email:mermaid30@163.com

摘要/Abstract

摘要： 目的探究妊娠期肝内胆汁淤积症中无症状乙型肝炎病毒(HBV)感染的发生情况及妊娠结局的影响。方法选取2018年1月—2022年12月期间入院诊治并终止妊娠的慢性HBV感染孕产妇112例,根据孕期空腹胆汁酸水平,将研究对象分为高胆汁酸组(TBA≥10 μmol/L)(n=56)和低胆汁酸组(TBA<10 μmol/L)(n=56)。比较高胆汁酸组和低胆汁酸组基线资料、血清学指标和妊娠结局。结果比较基线资料可知,高胆汁酸组高龄比例为37.5%,显著高于低胆汁酸组(19.6%)(P<0.05);比较血清学指标可知,高胆汁酸组ALTmax>40(U/L)比例、ASTmax>35(U/L)比例、GGTmax>32(U/L)比例和DNAmax>2×10⁵(IU/mL)比例分别为64.2%、64.2%、33.9%和64.2%,显著高于低胆汁酸组(12.5%、17.8%、5.3%和23.2%)(P<0.05);比较妊娠结局可知高胆汁酸组早产发生率和剖宫产比例分别为14.2%和71.4%,显著高于低胆汁酸组(3.5%和35.7%)(P<0.05),高胆汁酸组分娩孕周为(37.8±1.5)周,显著低于低胆汁酸组[(38.8±1.5)周(P<0.05)]。结论妊娠期肝内胆汁淤积症孕产妇不良妊娠结局发生率较高,无症状HBV感染发生率较高,对于妊娠期高胆汁酸孕产妇应加强监护。

关键词: 妊娠, 肝内胆汁淤积症, 乙型肝炎病毒

Abstract: Objective To investigate the prevalence of asymptomatic hepatitis B virus infection in intrahepatic cholestasis of pregnancy and its impact on pregnancy outcome.Methods A total of 112 pregnant women with chronic HBV infection, who were admitted for treatment and underwent pregnancy termination between January 2018 and December 2022, were included in the study. Based on fasting bile acid levels during pregnancy, participants were classified into a high bile acid group (TBA ≥ 10 μmol/L) (n=56) and a low bile acid group (TBA<10 μmol/L) (n=56). Baseline characteristics, serological markers, and pregnancy outcomes were compared between the two groups.Results Comparison of baseline data revealed that the proportion of elderly individuals in the high bile acid group was 37.5%, significantly higher than that in the low bile acid group (19.6%) (P<0.05). Serological analysis showed that the ratios of ALTmax>40 (U/L) ratio, ASTmax >35 (U/L), GGTmax >32 (U/L), and DNAmax >2×10⁵ (IU/mL) in the high bile acid group were 64.2%, 64.2%, 33.9% and 64.2% respectively, significantly higher than those in the low bile acid group (12.5%, 17.8%, 5.3% and 23.2%) (P<0.05). Regarding pregnancy outcomes, the high bile acid group had a significantly higher incidence of preterm birth (14.2%) and cesarean section (71.43%) compared to the low bile acid group (3.5% and 35.7%, respectively) (P<0.05). The mean gestational age at delivery in the high bile acid group was 37.8 ±1.5 weeks, significantly lower than the low bile acid group (38.8±1.5 weeks) (P<0.05)].Conclusion Pregnant women with intrahepatic cholestasis of pregnancy exhibit a higher incidence of adverse pregnancy outcomes and a greater prevalence of asymptomatic hepatitis B virus infection. Closer monitoring is recommende for pregnant women with elevated bile acid levels.

Key words: Pregnancy, Intrahepatic cholestasis, Hepatitis B virus

钱二艳, 龚咪, 王莉娟, 刘瑜. 妊娠期肝内胆汁淤积症中无症状HBV感染的发生情况及妊娠结局的影响[J]. 肝脏, 2024, 29(12): 1558-1560.

QIAN Er-yan, GONG Mi, WANG Li-juan, LIU Yu. Prevalence of asymptomatic hepatitis B virus infection in intrahepatic cholestasis of Pregnancy and its impact on pregnancy outcome[J]. Chinese Hepatolgy, 2024, 29(12): 1558-1560.

/ 推荐

参考文献

[1] Li X, Kong Y, Ren Y, et al. The impact of maternal intrahepatic cholestasis during pregnancy on the growth trajectory of offspring: a population-based nested case control cohort study[J]. BMC Pregnancy Childbirth, 2024, 24(1):413.
[2] Zhu Q, Shao X, Chen S, et al. Epidemiological serosurvey of hepatitis B virus among children aged 1-14 years in Guangdong province, China[J]. Int J Infect Dis, 2018, 71: 25-29.
[3] Tse KY, Ho LF, Lao T. The impact of maternal HBsAg carrier status on pregnancy outcomes: a case-control study[J]. J Hepatol, 2005, 43(5): 771-775.
[4] Tan J, Liu X, Mao X, et al. HBsAg positivity during pregnancy and adverse maternal outcomes: a retrospective cohort analysis[J]. J Viral Hepat, 2016, 23(10): 812-819.
[5] Wan Z, Zhou A, Zhu H, et al. Maternal hepatitis B virus infection and pregnancy outcomes: a hospital-based case-control study in Wuhan, China[J]. J Clin Gastroenterol, 2018, 52(1): 73-78.
[6] 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. 实用肝脏病杂志, 2023, 26(3):后插1-后插22.
[7] Huang X, Gu H, Shen P, et al. Systematic review and meta-analysis: Evaluating the influence of intrahepatic cholestasis of pregnancy on obstetric and neonatal outcomes[J]. PLoS One, 2024, 19(6):e0304604.
[8] 卫雅娴, 李丽, 付丽华, 等. 妊娠期肝内胆汁淤积症合并乙型肝炎病毒感染孕妇血液指标及母婴预后[J]. 中国肝脏病杂志(电子版),2023,15(1):62-68.
[9] Wang L, Li L, Huang C, et al. Maternal chronic hepatitis B virus infection does not affect pregnancy outcomes in infertile patients receiving first in vitro fertilization treatment[J]. Fertil Steril, 2019, 112(2): 250-257 e251.
[10] Wu K, Wang H, Li S, et al. Maternal hepatitis B infection status and adverse pregnancy outcomes: a retrospective cohort analysis[J]. Arch Gynecol Obstet, 2020, 302(3): 595-602.
[11] Xiong Y, Liu C, Huang S, et al. Impact of maternal infection with hepatitis B virus on pregnancy complications and neonatal outcomes for women undergoing assisted reproductive technology treatment: a population-based study[J]. J Viral Hepat, 2021, 28(4): 613-620.
[12] Shen GF, Ge CH, Shen W, et al. Association between hepatitis C infection during pregnancy with maternal and neonatal outcomes: a systematic review and meta-analysis[J]. Eur Rev Med Pharmacol Sci, 2023, 27(8): 3475-3488.
[13] 熊海燕, 罗业飞, 刘海燕, 等. 酶联免疫吸附试验和电化学发光免疫法检测孕妇乙型肝炎表面抗原结果的比较[J]. 中华流行病学杂志, 2017, 38(11):1537-1540.
[14] Huang S, Xia W, Li Y, et al. Association between maternal urinary chromium and premature rupture of membranes in the healthy baby cohort study in China[J]. Environ Pollut, 2017, 230: 53-60.
[15] Wang MD, Tang SC, Li C, et al. Association of concurrent metabolic syndrome with long-term oncological prognosis following liver resection for hepatocellular carcinoma among patients with chronic hepatitis B virus infection: a multicenter study of 1753 patients[J]. Ann Surg Oncol, 2023, 30(1): 346-358.
[16] Xia S, Ding J, Zhang Z, et al. Cluster of differentiation 24 polymorphism has no significant association with chronic hepatitis B virus infection in the chinese Han population: a family-based association study[J]. Infect Drug Resist, 2022, 15: 4837-4843.