乙型肝炎病毒携带孕妇双胎妊娠的结局分析  

Twin pregnancy outcomes of maternal hepatitis B virus carrier state

作　　者：芮燕京[1] 戴毅敏[1] 宋文英[1] 陈洁[1] 周乙华[1] 胡娅莉[1] 王志群[1] 

机构地区：[1]南京医科大学鼓楼临床医学院妇产科,210008

出　　处：《中华围产医学杂志》2014年第6期370-373,共4页Chinese Journal of Perinatal Medicine

摘　　要：目的：探讨乙型肝炎病毒（hepatitis B virus，HBV）携带对双胎妊娠结局的影响。方法2004年1月至2012年12月，在南京医科大学鼓楼临床医学院妇产科分娩的双胎妊娠孕妇共569例，其中32例妊娠前乙型肝炎病毒表面抗原（hepatitis B surface antigen，HBsAg）阳性， e抗原阴性且肝功能正常，确诊HBV携带，作为HBsAg阳性组；另外537例孕妇HBsAg阴性，作为HBsAg阴性组。回顾性分析这些孕妇的妊娠结局。采用t检验及χ^2检验比较2组间妊娠结局的差异，采用多元线性回归分析探讨影响新生儿出生体重的因素。结果 HBsAg阳性组孕妇发生肝功能损害（妊娠期丙氨酸转氨酶≥50 U/L）的比例明显高于HBsAg阴性组[18.8%（6/32）与5.8%（31/537），χ^2=6.367，P=0.012]。HBsAg阳性组孕妇妊娠期糖尿病的发生率高于HBsAg阴性组，但差异无统计学意义[21.9%（7/32）与11.6%（62/537），χ^2=2.132，P=0.144]。HBsAg阳性组妊娠期肝内胆汁淤积症、妊娠期高血压疾病、胎膜早破、前置胎盘、胎儿窘迫、产后出血、早产、剖宫产、胎儿脐带绕颈、羊水粪染、新生儿窒息发生率与HBsAg阴性组相比，差异均无统计学意义（P值均〉0.05）。多因素分析显示，妊娠期糖尿病（β=67.869，95%CI：0.494～135.244， P=0.048）、孕妇年龄（β=6.592，95%CI：2.020～11.880，P=0.006）和分娩孕周（β=164.069，95%CI：154.426～173.712，P〈0.01）对新生儿出生体重均有影响；而孕妇HBsAg阳性对新生儿出生体重的影响无统计学意义（β=78.864，95%CI：-16.950～174.678，P=0.107）。结论 HBV携带者双胎妊娠时易发生肝功能损害，但并不影响其他不良妊娠结局和新生儿疾病的发生风险。To investigate the impact of maternal hepatitis B virus （HBV） carrier state on twin pregnancy outcomes. Methods From January 2004 to December 2012, 569 women with twin pregnancy were hospitalized in Nanjing Drum Tower Hospital. Thirty-two women positive for hepatitis B surface antigen （HBsAg）（negative for hepatitis B e antigen, with normal liver function before conception）were included in the HBsAg-positive group and the other 537 women were included in the HBsAg-negative group. The pregnancy outcomes of the two groups were compared by t test and Chi-square test. The risk factors for neonatal birth weight were analyzed by multivariate regression analysis. Results Compared with the HBsAg-negative group, the HBsAg-positive women had a higher incidence of abnormal liver function （alanine aminotransferase≥50 U/L） [18.8% （6/32） vs 5.8% （31/537）, χ^2=6.367, P=0.012]. The incidence of gestational diabetes mellitus was 21.9% （7/32） in the HBsAg-positive group, which was higher than in the HBsAg-negative group [11.6% （62/537）], although the difference was not significant （χ^2=2.132, P=0.144）. The incidences of intrahepatic cholestasis of pregnancy,hypertensive disorders complicating pregnancy, premature rupture of membranes, placenta previa, fetal distress, postpartum hemorrhage, preterm birth, caesarean section, umbilical cord around the neck, meconium-staining amniotic fluid and neonatal asphyxia were no statistical difference between two groups （all P〈0.05, respectively）. Multivariate regression analysis showed that gestational diabetes mellitus （β=67.869, 95%CI： 0.494-135.244, P=0.048）, maternal age （β=6.592, 95%CI： 2.020-11.880,P=0.006） and gestational age （β=164.069, 95%CI：154.426-173.712, P〈0.01） were risk factors for neonatal birth weight, but not the maternal HBsAg-positive status （β=78.864, 95%CI： -16.950-174.678, P=0.107）. Conclusion Twin pregnancy and HBV carrier state increase the risk of abnormal liver function, but not other adverse

关 键 词：肝炎病毒 乙型 带病原状态 妊娠并发症 双生 妊娠结局 

分 类 号：R714.251[医药卫生—妇产科学]