摘要
目的探讨妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)合并乙型肝炎病毒(hepatitis B virus,HBV)感染孕妇的血液指标及围产结局。方法回顾性收集2008年1月1日至2020年12月31日于首都医科大学附属北京地坛医院妇产科分娩孕妇的临床资料,按照孕期是否存在ICP分为ICP组(491例)和非ICP组(504例),根据HBV感染情况,将ICP组分为ICP合并HBsAg阳性组[记为A组,401例,其中HBV DNA阳性208例(A1组),HBV DNA阴性193例(A2组)]和单纯ICP组(记为B组,80例);将非ICP组分为单纯HBV感染组(记为C组,200例)和无ICP无HBV感染组(记为D组,304例)。比较各组母婴不良结局,包括胎死宫内、胎儿窘迫、新生儿窒息、早产、低出生体重儿、产后出血、低婴儿重量指数(ponderal-index,PI),比较合并HBV感染的ICP孕妇在发病时总胆汁酸(total bile acids,TBA)、丙氨酸氨基转移酶(alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、总胆红素(total bilirubin,TBil)水平、重度ICP比例及发病孕周与无肝炎ICP孕妇的差异。结果各组患者年龄及产次无统计学差异(P均>0.05)。孕期ICP发病时,同时合并HBV感染孕妇(A1组与A2组)中重度ICP患者比例、TBA、ALT、AST水平均显著高于单纯ICP患者(B组),发病孕周也显著提前,其中HBV DNA阳性孕妇(A1组)中重度ICP患者比例,TBA、ALT、AST水平显著高于HBV DNA阴性孕妇(A2组),发病孕周也显著提前(P<0.05),而组间TBil差异无统计学意义(P>0.05)。ICP孕妇发生胎死宫内[1.19%(6/491)vs 0]、早产[23.63%(116/491)vs 10.12%(51/504)]、产后出血[11.8%(58/491)vs 3.2%(16/504)]的不良妊娠结局比例均显著高于无ICP组,且分娩孕周偏早[(37.52±1.955)周vs(39.09±1.341)周],剖宫产比例更高[67.82%(333/491)vs 34.92%(176/504)]。合并HBV感染的ICP孕妇,不良妊娠结局比例较单纯ICP孕妇升高,组间差异均有统计学意义(P均<0.05)。与其他组相比,A组孕妇的新生儿�
Objective To investigate the blood parameters and perinatal outcomes of intrahepatic cholestasis of pregnancy(ICP)patients with hepatitis B virus(HBV)infection.Methods Clinical data of pregnant women who delivered at the Department of Obstetrics and Gynaecology,Beijing Ditan Hospital,Capital Medical University from January 1st,2008 to December 31st,2020 were retrospectively collected.According to the presence or absence of ICP during pregnancy,they were divided into ICP group(491 cases)and non ICP group(504 cases).According to the HBV infection status,patients in ICP group were divided into ICP combined with HBsAg positive group[marked as group A,401 cases,among which 208 cases were with HBV DNA positive(group A1)and 193 cases were with HBV DNA negative(group A2)]and simple ICP group(marked as group B);patients in non ICP group were divided into simple HBV infection group(marked as group C,200 cases)and non-ICP-non-HBV infection group(marked as group D,304 cases).Maternal and fetal adverse outcomes including intrauterine fetal death,fetal distress,neonatal asphyxia,preterm delivery,low birth weight infants,postpartum haemorrhage,low infant weight index(PI)were compared.Total bile acid(TBA),alanine transaminase(ALT),aspartate transaminase(AST),total bilirubin(TB)levels at onset,proportion of severe ICP and gestational age at onset were compared between patients in group A and group D.Results There were no significant differences in age and parity among the groups(all P>0.05).At the onset of ICP during pregnancy,the proportion of moderate and severe ICP,TBA,ALT and AST levels in pregnant women with HBV infection(group A1 and A2)were significantly higher than those of simple ICP group(group B),the onset gestational age was also significantly earlier.the proportion of moderate and severe ICP,TBA,ALT and AST levels in group A1 were significantly higher than those of group A2,the onset gestational age was also significantly earlier(all P<0.05),there was no significant difference in TBil between the groups(P>0.05).The p
作者
卫雅娴
李丽
付丽华
王文静
康晓迪
Wei Yaxian;Li Li;Fu Lihua;Wang Wenjing;Kang Xiaodi(Department of Gynaecology and Obstetrics,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)
出处
《中国肝脏病杂志（电子版）》
CAS
2023年第1期62-68,共7页
Chinese Journal of Liver Diseases：Electronic Version
基金
首都医科大学附属北京地坛医院基金(DTMY201610)。
