妊娠合并乙型肝炎病毒感染的妊娠结局分析研究

发布时间：2018-11-03 21:15

【摘要】：目的：观察妊娠合并乙型肝炎病毒（HBV）感染母婴结局，提高对妊娠合并HBV感染孕妇管理的认识，，加强对妊娠合并HBV感染的母婴监测，改善母婴结局。方法：选取2013年1月至2014年2月在广西医科大学第一附属医院产前检查并分娩、孕期初诊为HBV感染（血清HBsAg阳性）的孕妇40例，作为妊娠合并HBV感染妊娠结局的研究对象，其中肝功能异常者12例，肝功能正常者28例；随机选取相同医院、同期血清HBsAg阴性并且肝功能正常的孕妇60例作为对照组。所以孕妇排除了甲、丙、丁、戊型肝炎病毒感染，无其他肝胆疾病；排除可能影响妊娠结局的胎盘早剥、胎盘前置、糖尿病等合并症。对所选病例的临床资料进行回顾性分析，比较肝功能正常组、异常组和对照组三组母婴结局。结果：1.肝功能正常组、异常组和对照组孕妇早产、胎儿窘迫、妊娠期高血压疾病、胎膜早破及产后出血发生率，肝功能异常组最高、对照组最低。肝功能异常组与对照组比较，早产、妊娠期高血压疾病和产后出血发生率明显较高（25.0%vs3.3%、P=0.03，33.3%vs5.0%、P=0.013，33.3%vs3.3%、P=0.004）；胎儿窘迫、胎膜早破发生率略高，无明显差异（P0.05）。三组剖宫产率之间均无明显差异（P0.05）。2.肝功能异常组低体重儿、新生儿窒息和死胎发生率最高，低体重儿发生率明显高于对照组（25.0%vs3.3%、P=0.03）；新生儿窒息发生率略高于肝功能正常组和对照组，无明显差异（P0.05）。肝功能正常组低体重儿和新生儿窒息发生率略高对照组，无显著差异(P0.05）。结论：妊娠合并HBV感染对母婴结局造成不良影响,尤其存在肝功能异常时对母儿危害更大；对孕妇常规地进行HBV血清学和肝功能检测，重视产前检查和围生期监测，以改善母婴结局。妊娠合并HBV感染不增加剖宫产率、对分娩方式影响较小。
[Abstract]:Objective: to observe the maternal and infant outcome of pregnancy with hepatitis B virus (HBV) infection, to improve the management of pregnant women with HBV infection, to strengthen the maternal and infant monitoring of pregnancy complicated with HBV infection, and to improve the maternal and infant outcome. Methods: from January 2013 to February 2014, 40 pregnant women with HBV infection (serum HBsAg positive) at the first affiliated Hospital of Guangxi Medical University were selected as the study objects of pregnancy complicated with HBV infection. There were 12 cases with abnormal liver function and 28 cases with normal liver function. 60 pregnant women with negative serum HBsAg and normal liver function in the same hospital were randomly selected as control group. So pregnant women excluded hepatitis A, C, D, E virus infection, no other hepatobiliary diseases; exclusion of placental abruption, placenta previa, diabetes and other complications that may affect the outcome of pregnancy. The clinical data of the selected cases were analyzed retrospectively to compare the maternal and infant outcomes of normal liver function group, abnormal group and control group. Results: 1. In normal liver function group, abnormal group and control group, the incidence of premature delivery, fetal distress, hypertensive disorder complicating pregnancy, premature rupture of membranes and postpartum hemorrhage were the highest in the abnormal group and the lowest in the control group. The incidence of preterm labor, hypertension complicating pregnancy and postpartum hemorrhage in the abnormal liver function group was significantly higher than that in the control group (25.0 vs 3.3%). Fetal distress, premature rupture of membranes slightly higher, there was no significant difference (P0.05). There was no significant difference in cesarean section rate among the three groups (P0.05). The incidence of asphyxia and stillbirth was the highest in the group with abnormal liver function, and the incidence of low birth weight was significantly higher than that in the control group (25.0 vs 3.3%). The incidence of neonatal asphyxia was slightly higher than that of normal liver function group and control group, and there was no significant difference (P0.05). The incidence of low birth weight infants and neonatal asphyxia in normal liver function group was slightly higher than that in control group (P0.05). Conclusion: pregnancy with HBV infection has a negative effect on the outcome of mother and child, especially when there is abnormal liver function, it is more harmful to mother and infant. Routine HBV serology and liver function test were performed on pregnant women, and prenatal examination and perinatal monitoring were emphasized to improve the outcome of mother and child. Pregnancy complicated with HBV infection did not increase the rate of cesarean section, but had little effect on delivery mode.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.251

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