HBV感染孕妇总胆汁酸升高的临床特点和危险因素分析  

Clinical characteristics and risk factors in pregnant women with hepatitis B virus infection and increase of total bile acid

作　　者：陈志英 于春燕 闫冀焕[3] 李妍 CHEN Zhiying;YU Chunyan;YAN Jihuan(Department of Clinical Laboratory,Shijiazhuang Hospital for Maternal and Child Health,Hebei,Shijiazhuang 050000,China;不详)

机构地区：[1]河北省石家庄市妇幼保健院检验科,050000 [2]河北省石家庄市妇幼保健院产科,050000 [3]河北国际旅行卫生保健中心石家庄海关口岸门诊部病原检测部

出　　处：《河北医药》2022年第9期1342-1345,共4页Hebei Medical Journal

基　　金：河北省医学科学研究课题计划(编号:20210169)。

摘　　要：目的分析乙型肝炎病毒(hepatitis B virus,HBV)感染孕妇总胆汁酸(total bile acid,TBA)升高的临床特点和危险因素,探讨HBeAg对TBA升高的影响。方法回顾性分析2018年6月至2021年3月就诊并分娩的慢性HBV感染孕妇的临床资料,将妊娠期发生TBA升高的114例孕妇作为病例组,分析TBA升高的临床特点。随机选取114例妊娠期未出现TBA升高的同期就诊HBV感染孕妇作为对照组,比较2组的年龄、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、γ-谷氨酰基转移酶(GGT)、总胆固醇(CHO)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)以及妊娠期高血压、妊娠期糖尿病、妊娠期亚临床甲状腺功能减退的发生率,分析HBV感染孕妇发生TBA升高的危险因素。将病例组进一步分为HBeAg阳性组62例和HBeAg阴性组52例,比较两者之间的差异。结果分娩的慢性HBV感染孕妇中,2.29%发生TBA升高,平均年龄(30.31±4.53)岁,高龄(≥35岁)孕妇占19.30%。TBA升高发生平均孕周为(27.32±8.82)周,35.09%的孕妇发生TBA重度升高,57.02%的孕妇合并肝损伤,13.16%的孕妇合并TBIL升高。病例组的高龄比例、ALT、AST水平显著高于对照组,而病例组的HDL-C水平显著低于对照组(P<0.05)。二元Logistic回归分析发现,高龄、ALT、AST水平升高为TBA升高的独立危险因素,HDL-C升高为其保护因素。HBeAg阳性孕妇中TBA升高发生率为3.63%(62/1710),HBeAg阴性孕妇中TBA升高发生率为1.59%(52/3269)。HBeAg阳性组与HBeAg阴性组年龄、合并ALT升高、合并AST升高以及TBA初始升高孕周比较,差异均有统计学意义(P<0.05)。结论高龄、肝损伤为HBV感染孕妇TBA升高的独立危险因素,且HBeAg阳性孕妇较早发生TBA的升高;识别以上高危因素,加强孕期监测,对疾病的早发现早诊治具有重要意义。Objective To investigate the clinical characteristics and risk factors in pregnant women with hepatitis B virus(HBV)infection and increase of total bile acid(TBA),and to explore the effects of HBeAg on TBA elevation.Methods The clinical data of pregnant women with chronic HBV infection who were treated in our hospital from June 2018 to March 2021 were retrospectively analyzed,the 114 pregnant women with TBA elevation were enrolled as case group,and the other 114 pregnant women without TBA elevation were enrolled as control group.The patient’s age,and the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),γ-glutaminyltransferase(GGT),total cholesterol(CHO),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),and the incidence of gestational hypertension,gestational diabetes,and gestational subclinical hypothyroidism were observed and compared between the two groups.Moreover the patients in case group were dedivided into HBeAg positive group and HBeAg negative group,and the differences between the two groups were compared.Results Of the pregnant women with chronic HBV infection,the TBA increase accounted for 2.29%,the mean age was(30.31±4.53)years,and the elderly(≥35 years)accounted for 19.30%.The average gestational weeks of elevated TBA were(27.32±8.82)weeks,and 35.09%of pregnant women had severe elevated TBA,57.02%of them had liver injury,and 13.16%of them had elevated TBIL.The proportion of elderly pregnant women,and the levels of ALT and AST in case group were significantly higher than those in control group(P<0.05),however,the HDL-C levels were significantly lower than those in control group(P<0.05).Binary Logistic regression analysis showed that older age,elevated levels of ALT and AST were independent risk factors for elevated TBA,and elevated HDL-C was its protective factor.The incidence of elevated TBA was 3.63%(62/1710)in HBeAg positive pregnant women and 1.59%(52/3269)in HBeAg negative pregnant women.There were significant differences in patient’s age,combined ALT i

关 键 词：乙型肝炎病毒 妊娠 总胆汁酸 妊娠期肝内胆汁淤积 危险因素 

分 类 号：R512.62[医药卫生—内科学]