妊娠合并病毒性肝炎相关指标特点分析

发布时间：2018-06-07 20:37

本文选题：妊娠 + 肝炎　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:分析妊娠合并肝炎的病因、诊断、治疗及预后。方法:对39例肝炎孕妇的临床资料按早中期妊娠与晚期妊娠分2组,比较其重型肝炎的发生率、病死率、肝功能各项指标及转归,比较39例中32例妊娠合并乙型病毒性肝炎的病人使用替比夫定抗病毒各指标改善情况以及患者不同HBV-DNA的血清表型。按HBV-DNA载量水平,比较替比夫定抗病毒组与非抗病毒组的存活率,根据并发症情况分析孕产妇及胎儿的预后。对其中非重型肝炎与重型肝炎分组,比较其并发症的有无差异性,比较黄疸病人药物干预前后瘙痒评分的差异性。结果:HBV感染是妊娠合并肝炎的主要原因,妊娠早中期与妊娠晚期比较,晚期发生重型肝炎发病率及病死率高,黄疸最高时ALT、AST、TBIL、DBIL、PT在妊娠早中期与妊娠晚期差异有统计学意义(P0.05),患者血清表型在HBV-DNA高病毒载量情况下,以1,3,5为优势表型,低病毒载量情况下,1、4、5为优势表型。在HBV-DNA高病毒载量情况下抗病毒组与非抗病毒组比较,差异有统计学意义(P0.05)。肝肾综合征、上消化道出血、弥漫性血管内凝血、自发性腹膜炎、失血性休克、肝性脑病及死胎的发生率在重型肝炎中与非重型肝炎比较,差异有统计学意义(P0.05)。在干预前后非重型肝炎瘙痒评分差异有统计学意义(P0.05),干预前后重型肝炎差异无统计学意义(P0.05)。结论:晚期妊娠合并肝炎病情重,合并多种并发症,预后差。在临床实践中,应对临床和生化指标严密的动态观察。同时,积极综合治疗和及时终止妊娠是改善预后的关键。
[Abstract]:Objective: to analyze the etiology, diagnosis, treatment and prognosis of pregnancy complicated with hepatitis. Methods: the clinical data of 39 pregnant women with hepatitis were divided into two groups according to early and middle pregnancy and third trimester pregnancy. The incidence, mortality, liver function and prognosis of severe hepatitis were compared. The improvement of tibivudine antiviral index and the serum phenotype of different HBV-DNA were compared in 32 of 39 pregnant women with viral hepatitis B. The survival rate of tibivudine antiviral group was compared with that of non-antiviral group according to HBV-DNA load. The prognosis of pregnant women and fetus was analyzed according to the complications. Among them, non-severe hepatitis and severe hepatitis were divided into two groups to compare the difference of complications and the score of pruritus in jaundice patients before and after drug intervention. Results the infection of HBV was the main cause of hepatitis in pregnancy. The incidence and mortality of severe hepatitis in the late stage were higher than that in the second trimester of pregnancy. There was significant difference in serum phenotype between early and third trimester of pregnancy (P 0.05) when the highest level of jaundice was found. The dominant phenotypes of serum phenotypes of patients with high HBV-DNA load were 1C 3N 5, and those with low viral load were 1 TBILD 5 as dominant phenotypic. The results showed that the serum phenotype of the patients with high HBV-DNA load was higher than that of the control group (P < 0.05). Under the condition of high viral load of HBV-DNA, the difference between antiviral group and non-antiviral group was statistically significant (P 0.05). The incidence of hepatorenal syndrome, upper gastrointestinal hemorrhage, diffuse intravascular coagulation, spontaneous peritonitis, hemorrhagic shock, hepatic encephalopathy and stillbirth in patients with severe hepatitis was significantly higher than that in non-severe hepatitis patients (P 0.05). There was significant difference in pruritus score of non-severe hepatitis before and after intervention (P 0.05), but there was no significant difference in severe hepatitis before and after intervention (P 0.05). Conclusion: the prognosis of late pregnancy with hepatitis is poor. In clinical practice, strict dynamic observation of clinical and biochemical indexes should be carried out. At the same time, active comprehensive treatment and timely termination of pregnancy is the key to improve prognosis.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.251

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