乙型肝炎病毒感染及肝功能状态对妊娠糖尿病发生的影响  

Influence of hepatitis B virus infection and liver function status on the occurrence of gestational diabetes mellitus

作　　者：曲嘉琳[1] 邹伟 罗婷婷 Qu Jia-Lin;Zou Wei;Luo Ting-Ting(Department of Clinical Laboratory,Women and Children's Hospital of Chongqing Medical University/Chongqing Health Center for Women and Children,Chongqing 401147,China)

机构地区：[1]重庆医科大学附属妇女儿童医院/重庆市妇幼保健院检验科,重庆401147

出　　处：《解放军医学杂志》2023年第2期218-223,共6页Medical Journal of Chinese People's Liberation Army

摘　　要：目的 探讨乙型肝炎病毒(HBV)感染和肝功能状态对妊娠糖尿病(GDM)发生发展的影响。方法 收集2018年1月-2021年10月在重庆市妇幼保健院行产前检查并分娩的628例孕妇的病历资料进行回顾性分析。根据是否感染HBV将所有孕妇分为HBV感染阳性组(n=389)与HBV感染阴性组(n=239),HBV感染阳性组再根据孕中期肝功能状态分为肝功能正常组(n=301)与肝功能异常组(n=88),分析HBV感染及肝功能状态对GDM发生发展的影响。然后,将符合GDM诊断标准的137例孕妇根据不同HBV感染状态分为HBV感染阳性组(n=97)和HBV感染阴性组(n=40),在HBV感染阳性组中,再根据孕中期肝功能状态分为肝功能正常组(n=62)与肝功能异常组(n=35),以分析HBV感染对GDM患者血糖及产后血糖转归和不良妊娠结局的影响。结果 HBV感染阳性组孕妇的妊娠期口服糖耐量试验(OGTT)1、2 h血糖水平波动较HBV感染阴性组明显,GDM发生率增高,且孕周明显缩短(P<0.05)。在HBV感染阳性的孕妇中,肝功能异常组孕妇的年龄,孕中期空腹血糖(FPG),OGTT 1、2 h血糖水平及GDM发生率均高于肝功能正常组(P<0.05)。肝功能异常的HBV感染GDM孕妇的孕中期OGTT 1、2 h血糖水平及产后6~12周的FPG水平、产后6~12周出现糖耐量受损的风险均高于肝功能正常的GDM孕妇(P<0.05)。合并HBV感染的孕妇二次妊娠时GDM发生率明显高于初次妊娠的孕妇(P<0.05);伴HBV感染且肝功能异常的GDM孕妇其剖宫产率及产后出血率均高于肝功能正常的GDM孕妇(P<0.05)。结论 HBV感染合并肝功能损害可使GDM发生率增高,且出现肝功能损害的HBV感染GDM患者发生不良妊娠结局的风险更高;HBV感染可能延长孕妇产后血糖代谢功能的恢复时间。Objective To investigate the effects of hepatitis B virus(HBV) and liver function status on the occurrence and development of gestational diabetes mellitus(GDM). Methods The medical data of 628 pregnant women, who underwent prenatal examination and delivery in Chongqing Health Center for Women and Children from January 2018 to October 2021, were collected and retrospectively analyzed. Depending on whether infected with HBV, the patients were divided into HBV positive group(n=389) and HBV negative group(n=239). Those in HBV positive group were then further divided into normal liver function group(n=301) and abnormal liver function group(n=88) according to the liver function status in the second trimester of pregnancy so as to analyze the influence of HBV infection and liver function status on the occurrence and development of GDM. A total of 137pregnant women who met the diagnostic criteria of GDM were divided into HBV positive group(n=97) and HBV negative group(n=40) according to the different HBV infection status. Those in HBV positive group were then divided into normal liver function group(n=62) and abnormal liver function group(n=35) according to their liver function status in the second trimester, so as to analyze the influence of HBV infection on blood glucose and postpartum blood glucose in GDM patients and adverse pregnancy outcomes. Results The fluctuation of blood glucose levels of pregnancy OGTT 1 h and 2 h was more obvious in pregnant women with positive HBV infection than those in negative group of HBV infection(P<0.05). The incidence of GDM was increased(24.9%vs. 16.7%) and gestational age was shortened in the pregnant women with positive HBV infection(P<0.05). Among the pregnant women with positive HBV infection, the average age, fasting blood glucose in the second trimester, OGTT 1 h, 2 h blood glucose and the incidence of GDM were higher in those with abnormal liver function(39.8% vs. 20.1%) than in those with normal liver function(P<0.05). HBV-infected GDM pregnant women with abnormal liver func

关 键 词：乙型肝炎病毒 妊娠糖尿病 孕妇 肝功能异常 

分 类 号：R512.62[医药卫生—内科学]