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目的探讨妊娠妇女乙型肝炎病毒(HBV)感染的肝功能、病毒学特点。方法对我院HBV感染的孕妇共259例资料进行回顾性分析,与60例慢性HBV感染未妊娠妇女相比较。用电化学发光法检测乙型肝炎两对半定量、荧光定量PCR法检测HBV DNA定量。结果 33.98%患者有HBV感染的家族史;非妊娠妇女的ALT、AST水平均较妊娠妇女明显升高;71.81%HBV感染的妊娠妇女肝功能正常,慢性乙型肝炎重度7例(2.70%);慢性乙型肝炎重型3例(1.16%);59.85%患者HBeAg(+),HBV DNA水平>5 log10 IU/ml患者63.71%,HBeAg阳性组孕妇的ALT、AST水平、HBV DNA定量较阴性组患者明显升高;HBeAg阳性组孕妇中,随着HBV DNA水平升高,ALT水平明显升高伴统计学意义,HBeAg阴性组孕妇中,随着HBV DNA水平升高,ALT、AST水平亦明显升高伴统计学意义;HBV DNA定量>5 log10 IU/ml妊娠妇女中高达46.06%ALT、AST水平升高。HBeAg阳性比例小于28岁的年轻孕妇(65.49%)显著高于年长孕妇(52.99%),28岁以上的年长孕妇发生肝功能损害发生率(34.19%)显著高于年轻孕妇(20.42%)。结论妊娠妇女HBV感染患者以HBeAg(+)为主,占59.85%,HBV DNA水平>5 log10 IU/ml者为多,占63.71%;71.81%患者肝功能正常;HBeAg阳性孕妇,肝功能异常较阴性患者明显,HBV DNA水平亦明显升高;无论是HBeAg阳性还是阴性患者,随着HBV DNA水平的升高,更容易出现肝损害;HBV DNA定量>5 log10 IU/ml妊娠妇女中46.06%肝功能异常。28岁以下年轻孕妇HBeAg阳性率65.49%高于年长孕妇,但肝功能异常率20.42%,低于年长孕妇。因此对HBV感染的孕妇需要密切观察肝功能、HBV DNA、HBeAg水平,特别是HBeAg阳性和HBV DNA水平较高的妊娠妇女需要警惕肝炎活动。建议HBV感染的女性28岁以前妊娠减少肝功能损害的风险。孕妇HBV感染的临床特征与母婴传播阻断的关系有待进一步探讨。
Objective To investigate the liver function and virological characteristics of hepatitis B virus (HBV) infection in pregnant women. Methods A total of 259 pregnant women with HBV infection in our hospital were retrospectively analyzed, which were compared with 60 non-pregnant women with chronic HBV infection. Electrochemical chemiluminescence (IHC) was used to detect HBV DNA in two pairs of semiquantitative and quantitative PCR for detection of HBV DNA. Results 33.98% of the patients had a family history of HBV infection. The levels of ALT and AST in non-pregnant women were significantly higher than those in pregnant women. Pregnant women with 71.81% HBV infection had normal liver function and severe hepatitis B in 7 (2.70%). 63.8% of patients with HBeAg (+) and HBV DNA level> 5 log10 IU / ml in 59.85% of the patients with HBeAg positive group had higher level of ALT and AST and HBV DNA than those in the negative group Significantly increased in HBeAg positive pregnant women, with the increase of HBV DNA levels, ALT levels were significantly increased with statistical significance, HBeAg-negative pregnant women, with the increase of HBV DNA levels, ALT, AST levels were significantly higher With statistical significance; HBV DNA quantitative> 5 log10 IU / ml pregnant women up to 46.06% ALT, AST levels. The incidence of hepatic dysfunction (34.19%) in older pregnant women over the age of 28 was significantly higher than that of the young pregnant women (20.42%), the young pregnant women whose HBeAg positive proportion was less than 28 years (65.49%) was significantly higher than the older pregnant women (52.99% . Conclusion The majority of HBeAg (+) HBV infection in pregnant women accounted for 59.85%, HBV DNA levels> 5 log10 IU / ml, accounting for 63.71%; 71.81% of patients with normal liver function; HBeAg-positive pregnant women, liver dysfunction than Negative patients obviously, HBV DNA levels also significantly increased; both HBeAg-positive or negative patients with HBV DNA levels increased, more prone to liver damage; HBV DNA quantitative> 5 log10 IU / ml in pregnant women, 46.06% of the liver Abnormal function. The positive rate of HBeAg in younger pregnant women under the age of 28 was 65.49% higher than that of the older pregnant women, but the abnormal rate of liver function was 20.42%, lower than that of the older pregnant women. Therefore, HBV infection in pregnant women need to closely observe the liver function, HBV DNA, HBeAg levels, especially in pregnant women with high levels of HBeAg and HBV DNA need to guard against hepatitis activity. Women with HBV infection are advised to reduce their risk of liver damage by pregnancy before age 28. The relationship between the clinical characteristics of pregnant women with HBV infection and mother-to-child transmission of the need to be further explored.