妊娠合并乙型肝炎肝硬化47例临床分析  

Clinical analysis of 47 pregnant cases with hepatitis B related cirrhosis

作　　者：白玉青[1] 李丽[1] 康晓迪[1] 刘华放 刘军[1] 蔡晧东[1] BAI Yu-qing;LI Li;KANG Xiao-di;LIU Hua-fang;LIU Jun;CAI Hao-dong(Department of Obstetrics,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院妇产科,北京100015

出　　处：《中国肝脏病杂志（电子版）》2018年第2期73-77,共5页Chinese Journal of Liver Diseases：Electronic Version

基　　金：首都特色应用研究(Z14110700250000;Z141107002514140);北京市医管局市属医院科研培育计划(PX2018060);北京市医管局青苗计划(QML20171803)

摘　　要：目的探讨乙型肝炎肝硬化及抗病毒治疗对妊娠的影响及妊娠结局的预测方法。方法对2009年1月至2016年12月在首都医科大学附属北京地坛医院诊治的47例妊娠合并乙型肝炎肝硬化患者的临床资料进行回顾性分析,依据孕期是否进行抗病毒治疗分为A组(22例)和B组(25例),A组患者孕期进行抗病毒治疗,B组患者孕期未进行抗病毒治疗。比较两组产妇和新生儿并发症的发生情况,并通过孕早期Child-Pugh分级和两项肝纤维化评估指标(APRI评分和FIB-4指数)对妊娠结局进行预测。结果孕早期B组患者ALT、AST、APRI评分和FIB-4指数均显著高于A组患者,差异有统计学意义(P均<0.05)。A组和B组患者孕早期HBV DNA低于检测下限比率分别为86.4%、20.0%(χ~2=20.624,P<0.001)。B组中因中度以上贫血、肝病加重及因不良事件住院的患者显著多于A组,A组和B组患者平均住院天数分别为(9.3±3.2)天、(15.7±12.2)天,差异有统计学意义(t=2.388,P=0.021),两组其他围产期产科并发症和胎儿结局差异无统计学意义。Child-Pugh B级或FIB-4≥4的16例患者中有8例出现妊娠不良结局,RR=7.750。结论乙型肝炎肝硬化患者在妊娠期间使用抗病毒药物治疗可降低肝病进展的风险和贫血等并发症的发生;Child-Pugh B级或FIB-4≥4的患者在妊娠期间发生肝功能失代偿或胎儿不良结局的风险增加。Objective To investigate the effects of the hepatitis B related cirrhosis and antiviral therapy on pregnancy and the predictive methods of pregnancy outcomes associated with liver cirrhosis.Methods The clinical data of 47 pregnant patients with hepatitis B related cirrhosis in Beijing Ditan Hospital,Capital Medical University from January 2009 to December 2016 were retrospectively analyzed.According to whether or not receiving antiviral therapy during pregnancy,the patients were divided into two groups:group A(22 cases)and group B(25 cases).Patients in group A received antiviral therapy and patients in group B did not receive antiviral therapy,the maternal and neonatal complications between the two groups were compared.Pregnancy outcomes were evaluated by Child-Pugh grading and two liver fibrosis assessments(APRI scores and FIB-4 index)during early pregnancy.Results ALT,AST,APRI scores and FIB-4 index of patients in group B were significantly higher than those in group A during the first trimester,the differences was statistically significant(P<0.05).The rates of HBV DNA below the lower detection limit in group A and group B were 86.4%and 20.0%,respectively(χ2=20.624,P<0.001).In group B,the number of hospitalized patients with moderate or more anemia,aggravated liver disease and adverse events were significantly higher than those in group A.The average days of hospitalization in group A and group B were(9.3±3.2)days and(15.7±12.2)days,respectively,the differences was statistically significant(t=2.388,P=0.021).Other perinatal obstetric complications and fetal outcomes had no statistically significant differences between the two groups.Out of 16 patients with Child-Pugh grade B or FIB-4≥4,8 cases had adverse pregnancy outcomes,RR=7.750.Conclusions Antiviral therapy in patients with hepatitis B related cirrhosis during pregnancy can reduce the risk of liver disease progression and complications such as anemia.Patients with Child-Pugh grade B or FIB-4≥4 have a higher risk of hepatic decompensation or fetal adv

关 键 词：肝硬化 妊娠结局 抗病毒 预测 

分 类 号：R714.25[医药卫生—妇产科学]