昆明地区孕妇乙型肝炎病毒携带与妊娠结局的关系 [中文引用][英文引用]

目的 调查昆明地区近10年来孕妇乙型肝炎病毒（hepatitis B virus , HBV）携带以及HBV DNA复制状态与产科结局的关系。方法 以2002年5月1日至2011年4月30日10年间在昆明医科大学第一附属医院产科分娩的20 854例产妇作为研究对象进行回顾性调查，分析孕妇HBV感染与某些妊娠不良结局的关系。结果 研究期间在本院分娩人数共为20 854例，其中HBV感染770例，总感染率为4.17%；在770例HBV感染中有529例（68.70%）进行HBV DNA检查，其中DNA阳性189例（25.55%）。HBV感染且DNA阳性组妊娠期糖尿病（gestational diabetes mellitus，GDM）发生率（15.87%）显著高于HBV阴性组（10.70%）（P＜0.05），HBV感染且 DNA阳性组妊娠期高血压疾病发生率（7.41%）高于HBV感染但 DNA阴性组（2.95%）和HBV阴性组（3.81%），差异均有统计学意义（P＜0.05）；HBV感染组妊娠期特异性肝病（intrahepatic cholestassis of pregrenancy，ICP和acute fatty liver in pregnancy，AFLP）发生率（1.95％）高于HBV阴性组（0.78％）（P＜0.05）。HBV感染组与HBV阴性组两组间分娩孕周、出生体重，新生儿窒息率、产后出血发生率差异无统计学意义（P＞0.05）。结论 母亲HBV感染或HBV-DNA病毒复制与GDM、妊娠期高血压疾病和某些妊娠期特异性肝病发生相关。

Objective This study aimed to explore the relationship between maternal HBV infectious status and pregnancy outcomes in Kunming pregnant women over the past 10 years. Method A retrospective cohort study was conducted on 20,854 consecutive pregnant women who delivered in the 1st Affiliated Hospital of Kunming Medical University from June 2002 to April 2011. HBV infectious status and pregnant outcomes were analyzed among these pregnant women. Results Of the 18 482 pregnant women who had the results of hepatitis B serological determination during the study period, a total of 770 (4.17%) women had HBV infection. Among 770 women, 529 (68.70%) completed HBV DNA quantitation and 189 (25.55%) were positive. The HBV infection and HBV DNA positive cohort had a significantly higher incidence of GDM compared with the HBsAg negative cohort (15.87% vs 10.70%, P＜0.05), and pregnancy induced hypertension had significantly higher incidence for the women of HBV infection and HBV DNA positive cohort when compared with the HBV infection and HBV DNA negative cohort (7.41% vs 2.95%, P＜0.05) and the HBsAg negative cohort (7.41% vs 3.81%, P＜0.05). In addition, the HBV infection cohort had higher incidence of ICP and AFLP compared with the HBsAg negative cohort (1.95% vs 0.78%, P＜0.05). Gestational age at delivery, neonatal birth weight, incidence of neonatal asphyxia and postpartum hemorrhage had no significant difference between the HBV infection cohort and the HBsAg negative cohort. Conclusions Maternal HBV infectious status is associated with the prevalence of GDM, pregnancy induced hypertention, ICP and AFLP.