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目的:探讨乙型肝炎病毒(HBV)感染在妊娠期肝内胆汁淤积症(ICP)发病中的作用。方法:收集2008年1月～2012年1月在该院产科产检并分娩的孕妇2 362例。2 362例孕妇根据HBV感染情况分为2组:HBV感染组(n=218)和非HBV感染组(n=2 144)。记录孕妇的肝功能生化指标(丙氨酸转氨酶、谷草转氨酶)、瘙痒出现时间、早产以及产后出血发生率等。结果:2 362例孕妇中ICP患者104例,发生率为4.4%,HBV感染者218例,感染率9.2%。HBV感染者中ICP的发生率为11.9%,而非HBV感染者中ICP的发生率为3.6%,两组之间具有统计学差异(P<0.05)。ICP孕妇的丙氨酸转氨酶(ALT)、谷草转氨酶(AST)水平显著低于ICP伴发HBV感染的孕妇(P<0.05)。ICP孕妇的瘙痒出现时间、早产以及产后出血发生率均显著低于ICP伴发HBV感染的孕妇(P<0.05)。结论:HBV感染参与了ICP的发生发展过程,加强对HBV感染孕妇的围生期监护,有利于ICP的早期发现和积极治疗以及妊娠结局的改善。
Objective: To investigate the role of Hepatitis B virus (HBV) infection in the pathogenesis of intrahepatic cholestasis of pregnancy (ICP). Methods: A total of 2 362 pregnant women undergoing obstetric examination and delivery in our hospital from January 2008 to January 2012 were collected. 2 362 pregnant women were divided into two groups based on the HBV infection: HBV infection (n = 218) and non-HBV infection (n = 2 144). Record biochemical indicators of liver function in pregnant women (alanine aminotransferase, aspartate aminotransferase), itching time, preterm birth and the incidence of postpartum hemorrhage. Results: Of the 2 362 pregnant women, 104 were ICP patients, with a prevalence of 4.4% and 218 cases of HBV infection. The infection rate was 9.2%. The incidence of ICP in HBV-infected persons was 11.9%, while that in non-HBV-infected persons was 3.6%. There was a significant difference between the two groups (P <0.05). The level of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in ICP pregnant women was significantly lower than that of ICP pregnant women with HBV infection (P <0.05). The occurrence of pruritus, premature labor and postpartum hemorrhage in ICP pregnant women were significantly lower than those in ICP pregnant women with HBV infection (P <0.05). Conclusion: HBV infection is involved in the development and progression of ICP, enhancing perinatal monitoring of HBV-infected pregnant women, facilitating early detection and aggressive treatment of ICP, and improving pregnancy outcomes.