摘要
目的探讨慢性HBV感染的孕妇出现妊娠期糖尿病(GDM)的相关因素、妊娠结局及其对所分娩新生儿的影响。方法回顾性纳入2017年1月—2017年12月于首都医科大学附属北京佑安医院就诊、分娩及产后随诊的317例慢性HBV感染的孕妇。根据是否合并GDM分为慢性HBV感染合并GDM组及慢性HBV感染对照组。记录入组孕妇的HBV血清学标志物、肝功能、HBV DNA定量、妊娠合并症、分娩方式及新生儿出生时情况。满足正态分布的计量资料的2组间比较采用t检验或t′检验,不满足正态分布的计量资料的2组间比较采用Mann-Whitney U检验;计数资料2组间比较采用χ^(2)检验或Fisher精确法检验;采用二元logistic多因素回归分析慢性HBV感染的母亲出现GDM的危险因素。结果317例母亲中慢性HBV感染合并GDM共64例,占整体人数20.19%,对照组为253例,占整体人数79.81%。慢性HBV感染合GDM组的孕妇在年龄(Z=-2.652)、基线ALT(Z=-4.393)、基线AST(Z=-2.457)及HBV DNA定量方面高于对照组(P值均<0.05)。logistic回归分析显示,HBV DNA定量[OR(95%CI)=23.40(7.10~77.14),P<0.001]及高龄[OR(95%CI)=1.10(1.02~1.17),P=0.01]是慢性HBV感染孕妇发生GDM的独立危险因素。慢性HBV感染合并GDM的孕妇在分娩时更容易出现胎膜早破(χ^(2)=4.514,P=0.034);所分娩的新生儿更容易出现早产(χ^(2)=9.293,P=0.002)及胎儿宫内窘迫(P=0.018)。结论HBV DNA定量及高龄是慢性HBV感染母亲发生GDM的危险因素。慢性HBV感染的孕妇合并GDM增加了胎膜早破、胎儿宫内窘迫及早产的发生率。
Objective To investigate the factors for gestational diabetes mellitus(GDM)in pregnant women with chronic hepatitis B virus(HBV)infection,their pregnancy outcome,and related influence on neonates.Methods A retrospective analysis was performed for 317 pregnant women with chronic HBV infection who were treated,gave birth,and were followed up in Beijing YouAn Hospital,Capital Medical University,from January to December 2017,and according to the presence or absence of GDM,they were divided into chronic HBV+GDM group and chronic HBV control group.Related data were recorded,including HBV serology,liver function,HBV DNA quantification,pregnancy comorbidities,mode of delivery,and the condition of neonates at birth.The t-test or t′-test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups;the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups;a binary logistic regression analysis was used to investigate the risk factors for GDM in mothers with chronic HBV infection.Results Among the 317 mothers,64(20.19%)had chronic HBV infection and GDM,and there were 253 mothers(79.81%)in the control group.Compared with the control group,the chronic HBV+GDM group had significantly higher age(Z=-2.652,P<0.05),baseline alanine aminotransferase(Z=-4.393,P<0.05),baseline aspartate aminotransferase(Z=-2.457,P<0.05),and HBV DNA quantification(P<0.05).The logistic regression analysis showed that HBV DNA quantification(odds ratio[OR]=23.40,95%confidence interval[CI]:7.10-77.14,P<0.001)and old age(OR=10.10,95%CI:1.02-1.17,P=0.01)were independent risk factors for GDM in pregnant women with chronic HBV infection.The pregnant women with chronic HBV infection and GDM were more likely to experience premature rupture of membranes during delivery(χ^(2)=4.514,P=0.034),and the neonates born to these women were more likely to experience preterm birth(χ^
作者
李璐
邹怀宾
徐曼曼
陈煜
LI Lu;ZOU Huaibin;XU Manman;CHEN Yu(Fourth Department of Liver Disease Center,Beijing YouAn Hospital,Capital Medical University,Beijing 100069,China;Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research,Beijing 100069,China)
出处
《临床肝胆病杂志》
CAS
北大核心
2021年第10期2303-2307,共5页
Journal of Clinical Hepatology
基金
国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治”(2017ZX10203201-005,2017ZX10201201-001-001,2017ZX10201201-002-002,2017ZX10201201-002-009,2017ZX10201201-004-002)。
关键词
乙型肝炎病毒
糖尿病
妊娠
孕妇
Hepatitis B Virus
Diabetes,Gestational
Pregnant Women
