慢性HBV感染对产后出血影响的Meta分析  

Hepatitis B virus(HBV) infection and postpartum haemorrhage: A meta-analysis

作　　者：梁海英 黄启涛[2] 周琳[3] 马倩倩[3] 佘秋敏 陈文倩[3] 高云飞[2] 余艳红[2] 钟梅[2] 

机构地区：[1]广东省江门市新会区妇女儿童医院产科,529100 [2]南方医科大学南方医院妇产科,广州市510515 [3]南方医科大学第一临床医学院,广州市510515

出　　处：《实用医学杂志》2016年第12期2035-2040,共6页The Journal of Practical Medicine

基　　金：国家自然青年基金(编号:81401208);广东省自然基金博士启动项目(编号:2015A030310025);广东省自然基金资助项目(编号:2013B021800142)

摘　　要：目的：评价HBV感染孕妇发生产后出血的风险，为临床应用提供证据。方法：采用计算机和手工检索主题词的方法，检索 PubMed、EMBASE、WileyOnline Library、Cochrane Library、Google Scholar、CNKI、CBM、维普、万方，检索时限从建库至2015年8月，查找有关HBV感染孕妇产后出血的相关研究，对纳入研究的文献进行质量评价，采用RevMan 5．2软件进行Meta分析。结果：最终纳入文献21篇，包括4篇病例对照研究和17篇队列研究，纳入孕妇共19549例。 Meta 分析结果显示，HBV感染孕妇产后出血的发生率为9．3％，而正常孕妇产后出血的发生率为2．8％，差异有统计学意义（RR ＝2．97，95％CI 为2．25～3．92，P ＜0．01）。肝功能正常的HBV感染孕妇与正常孕妇产后出血发生率比较（8．1％ vs．3．3％），差异有统计学意义（RR ＝2．56，95％CI为2．01～3．25，P ＜0．01）。肝功能异常的HBV感染孕妇产后出血发生率为22．3％，明显高于肝功正常的HBV感染孕妇8．1％，差异有统计学意义（RR ＝2．67，95％CI 为2．17～3．28，P ＜0．01）。结论：HBV感染孕妇产后出血发生风险高于正常孕妇，而肝功能异常的HBV感染孕妇产后出血发生风险进一步增高。Objective To investigate the risk of postpartum haemorrhage in HBV-infected pregnant women. Methods Cohort or case-control studies that discussed the relationship between hepatitis b virus infection and pregnancy outcome were searched in PubMed , EMBASE , Wiley Online Library , Cochrane Library , Google Scholar, CBM, WanFang database and CNKI etc. （till August 2015）. The quality of included Cohort or case-control studies was evaluated , and Meta-analysis was performed with Rev Man5.2 software. Results Four observational case-control studies and 17 cohort studies , involving 19 549 women in observation , were identifled. Meta-Analysis results displayed that the incidence of postpartum haemorrhage in HBV-infected women was 9.3%, while 2.8% in women without HBV [RR = 2.97, 95% CI （2.25 ~ 3.92）,P 〈 0.01]. Compared with normal-risk women , the incidence of postpartum haemorrhage of HBV-infected women with normal hepatic function was also higher [RR = 2.56, 95% CI （2.01 ~ 3.25）,P 〈 0.01]. HBV-infected women with hepatic dysfunction had higher incidence of postpartum haemorrhage than those with normal hepatic function [RR = 2.67, 95% CI （2.17~ 3.28）,P 〈 0.01]. Conclusions HBV-infected women are at higher risk of postpartum haemorrhage than normal pregnancy women and further hepatic dysfunction would lead to a continuing increase of the risk.

关 键 词：乙型肝炎病毒感染 妊娠 肝功能 妊娠结局 产后出血 

分 类 号：R714.461[医药卫生—妇产科学]