非活动性HBsAg妇女妊娠期及产后HBV再激活的临床特征及危险因素分析  

Clinical characteristics and risk factors of HBV reactivation in women with inactive HBsAg during pregnancy and postpartum

作　　者：符国骥 王桦[2] 许少珍[3] FU Guo-ji;WANG Hua;XU Shao-zhen(Department of Public Health,Qionghai Maternal and Child Health Hospital,Hainan Province,Qionghai 571400,China;Department of Women′s Health,Qionghai Maternal and Child Health Hospital,Hainan Province,Qionghai 571400,China;Department of Gynaecology,Qionghai Maternal and Child Health Hospital,Hainan Province,Qionghai 571400,China)

机构地区：[1]海南省琼海市妇幼保健院公共卫生科,海南琼海571400 [2]海南省琼海市妇幼保健院妇保科,海南琼海571400 [3]海南省琼海市妇幼保健院妇产科,海南琼海571400

出　　处：《河北医科大学学报》2024年第4期451-457,共7页Journal of Hebei Medical University

基　　金：海南省卫生健康行业科研项目。

摘　　要：目的分析非活动性乙型肝炎病毒表面抗原(hepatitis B virus surface antigen,HBsAg)妇女妊娠期及产后乙型肝炎病毒(hepatitis B virus,HBV)再激活的临床特征及危险因素分析。方法回顾性选取非活动性HBV携带孕妇116例为研究对象。分析妊娠期HBV再激活组与妊娠期HBV未再激活组的基线资料,构建基线资料的临床预测模型并评估模型科学性;分析妊娠期HBV再激活、产后HBV再激活及妊娠期+产后HBV再激活孕妇在HBV激活时的肝功能、免疫功能、肝纤维化指标及炎症因子水平;评估妊娠期HBV再激活影响因素对全因性产后HBV再激活的影响。结果妊娠期HBV再激活组基线HBV脱氧核糖核酸(deoxyribonucleic acid,DNA)、总胆固醇(total cholesterol,TC)、低密度脂蛋白(low density lipoprotein,LDL)水平、初产妇比例明显高于HBV未再激活组,年龄、家庭月收入水平明显低于HBV未再激活组(χ^(2)/t=7.004,5.934,4.805,3.853,10.561,7.289,P<0.05)。基线HBV DNA水平、年龄、家庭月收入对妊娠期HBV再激活具有一定的预测价值(c指数=0.653,AUC 5个月内=0.679,AUC 10个月内=0.742,P<0.05)。仅发生妊娠期HBV再激活组HBV DNA水平、血清透明质酸、层黏连蛋白、三型前胶原N端肽、四型胶原蛋白、C反应蛋白、白细胞介素6、肿瘤坏死因子α低于仅发生产后HBV再激活组、妊娠期+产后HBV再激活组,CD4^(+)、CD4^(+)/CD8^(+)水平明显高于仅发生产后HBV再激活组、妊娠期+产后HBV再激活组(F=5.123、4.835、5.035、17.329、14.924、16.392、14.320、7.852、14.824、6.392,P<0.05)。年龄较低孕妇容易发生全因性产后HBV再激活(P<0.05)。结论年龄低、基线HBV DNA水平高及家庭月收入低的患者容易发生妊娠期HBV再激活,产后HBV再激活所引起的免疫损伤可能较妊娠期更为严重,年龄低者容易发生全因性产后HBV再激活。Objective To analyze the clinical characteristics and risk factors of hepatitis B virus(HBV)reactivation in women with non-active hepatitis B virus surface antigen(HBsAg)during and after pregnancy.Methods In total,116 pregnant women who were non-active HBV carriers were retrospectively selected.Baseline data of HBV reactivation during pregnancy and non-HBV reactivation during pregnancy were analyzed to construct a clinical prediction model of baseline data and evaluate the scientificity of the model.The levels of liver function,immune function,liver fibrosis indexes and inflammatory factors during HBV activation were analyzed in pregnant women with HBV reactivation during pregnancy,after pregnancy as well as during pregnancy and after pregnancy.In the meantime,the factors influencing HBV reactivation during pregnancy on all-cause postpartum HBV reactivation was evaluated.Results Baseline HBV deoxyribonucleic acid(DNA)level,total cholesterol(TC),low density lipoprotein(LDL),and proportion of primipara in HBV reactivation during pregnancy group were significantly higher than those in non-HBV reactivation during pregnancy group,while age and family monthly income level were significantly lower than those in non-HBV reactivation during pregnancy group.Most HBV reactivation patients during pregnancy were primiparas(χ^(2)/t=7.004,5.934,4.805,3.853,10.561,7.289,P<0.05).Baseline HBV DNA level,age and monthly family income had certain predictive value for HBV reactivation during pregnancy(cindex=0.653,AUC five month=0.679,AUC ten month=0.742,P<0.05).HBV DNA levels,serum hyaluronic acid,laminin,N-terminal peptide of typeⅢprocollagen,typeⅣcollagen,C-reactive protein,interleukin-6,and tumor necrosis factorαin HBV reactivation during pregnancy group than in HBV reactivation after pregnancy group,while the levels of CD4^(+),CD4^(+)/CD8^(+)in pregnant HBV reactivation group were significantly higher than those in HBV reactivation after pregnancy group and those in HBV reactivation during and after pregnancy group(F=5.123,

关 键 词：妊娠 乙型肝炎病毒 乙型肝炎表面抗原 

分 类 号：R714.25[医药卫生—妇产科学]