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目的:探讨对免疫耐受期乙型肝炎病毒(HBV)感染女性孕期进行肝功能监测的临床意义。方法:回顾性分析该院妇产科2013年3月~2014年3月进行产检、生育并完成产后随访的免疫耐受期HBV感染女性共80例,根据产后肝功能分为肝功能异常组和正常组,每组40例,对比两组孕妇肝功能、HBV DNA水平、分娩方式、妊娠并发症发生率和产后婴儿HBs Ag和HBV DNA阳性率。结果:肝功能异常组的孕期平均丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血清总胆红素(TBIL)、直接胆红素(DBIL)和孕28周HBV DNA均显著高于肝功能正常组,P<0.01。两组孕妇的分娩方式无统计学差异,P>0.05;肝功能异常组的妊娠并发症发生率显著高于对照组,P<0.05。肝功能异常组的产后婴儿HBs Ag和HBV DNA阳性率显著高于肝功能正常组,χ2=5.000 0,P<0.05。结论:免疫耐受期HBV感染女性的孕期肝功能和病毒复制监测对其产后肝功能、妊娠结局和婴儿预后有重要影响,应加强对此类女性的孕期肝功能监测,必要时予以抗病毒治疗。
Objective: To investigate the clinical significance of monitoring liver function during pregnancy in women with immunocompromised hepatitis B (HBV) infection. Methods: A retrospective analysis of obstetrics and gynecology hospital from March 2013 to March 2014 for childbirth, childbirth and completion of postpartum immunocompromised women with HBV infection in 80 cases, according to postpartum liver function was divided into liver dysfunction group and Normal group, 40 cases in each group. The liver function, HBV DNA level, mode of delivery, the incidence of pregnancy complications and the positive rate of HBsAg and HBV DNA in postpartum infants were compared between the two groups. Results: Mean alanine aminotransferase (ALT), aspartate aminotransferase (AST), total serum bilirubin (TBIL), direct bilirubin (DBIL) and gestational age at 28 weeks HBV DNA were significantly higher than the normal liver function group, P <0.01. There was no significant difference in the mode of delivery among the two groups of pregnant women (P> 0.05). The incidence of pregnancy complications in the abnormal liver function group was significantly higher than that in the control group (P <0.05). The positive rates of HBsAg and HBV DNA in postpartum infants with abnormal liver function were significantly higher than those in normal liver function group (χ2 = 5.0000, P <0.05). CONCLUSIONS: Monitoring of liver function and virus replication in pregnant women with immune-refractory HBV infection during pregnancy has an important effect on post-natal liver function, pregnancy outcome and infant prognosis. Surveillance of liver function in these women should be strengthened and antiviral therapy should be given if necessary .