妊娠合并乙型肝炎病毒感染对妊娠结局的影响

目的：探讨妊娠合并乙肝病毒感染影响妊娠结局的因素。方法：采用回顾性方法分析了1989年1月至1992年12月期间183例妊娠期存在乙肝病毒感染者的妊娠结局。结果：(1)妊娠合并乙肝病毒感染各并发症的发生率：胎膜早破21．31％，早产12．02％，妊高征10．38％，胎儿窘迫12．02％，产后出血3．23％，新生儿窒息10．38％；(2)妊娠合并乙肝病毒感染有肝功能异常组与肝功能正常组相比其早产(28．17％)、妊高征(22．54％)、胎儿窘迫(25．35％)、产后出血(8．45％)发生率均明显增高，新生儿出生体重则明显降低。结论：妊娠合并乙肝病毒感染，易发生胎膜早破、早产、妊高征、胎儿窘迫及产后出血，肝功能异常对这些妊娠并发症的发生有显著影响。应重视该类病例的治疗。     

乙型肝炎病毒感染与妊娠肝内胆汁淤积症的相关性研究

目的　探讨无症状乙型肝炎病毒 (HBV)感染是否会影响妊娠肝内胆汁淤积症 (ICP)的发生率、病程及相关并发症。方法　 1997年 1月至 2 0 0 1年 7月对 76 5 1例孕妇进行乙型肝炎 (乙肝 )血清学测定 ,分析比较乙肝血清学HBV表面抗原 (HBsAg)、HBVe抗原 (HBeAg)及HBV核心抗体 (HBcAb)阳性孕妇与阴性孕妇其ICP发生、转归的相关性。结果　在有HBV感染的孕妇中其ICP的发生率明显高于无HBV感染的孕妇 (分别为 9 7%及 4 2 % ,P <0 0 0 1)。有HBV感染的孕妇发生ICP瘙痒症状的时间明显早于无HBV感染的孕妇 ,分别为( 2 8 8± 3 2 )周及 ( 32 1± 2 7)周 ,P <0 0 0 1。有HBV感染的ICP孕妇终止妊娠时间明显早于无HBV感染的ICP孕妇 ,分别为 ( 36 1± 0 9)周及 ( 37 8± 1 6 )周 ,P <0 0 0 1。在ICP组中有无HBV感染其早产发生率差异有非常显著性意义 ,分别为 2 9 5 %及 12 2 % ,P <0 0 0 1。ICP孕妇中有无HBV感染产后 2 4h内阴道出血量差异也有非常显著性意义 ,分别为 ( 335 0± 76 7)mL及 ( 2 78 0± 97 6 )mL ,P<0 0 0 1。结论　感染了HBV的孕妇其ICP的发生率增高 ,应加强对这些孕妇的孕期监护 ,并且积极防治早产及产后出血的发生。     

妊娠合并乙型肝炎病毒感染孕妇胎儿窘迫发病原因分析

目的：探讨妊娠合并乙型肝炎病毒（HBV）感染孕妇胎儿窘迫的病因、预后及治疗方法。方法：对81例妊娠期HBV表面抗原（HBsAg）、HBVe抗原（HBeAg)、HBV核心抗体（HBcAb)和HBV DNA均阳性,肝功能正常的孕妇及其新生儿（研究组）,85例无肝炎病毒感染,肝功能正常的孕妇及新生儿（对照组）的临床资料、血清学检查结果、胎盘病理检查结果和胎儿预后进行分析,并对研究组中76例婴儿在出生后0、1、6月龄时分别注射酵母菌重组乙型肝炎疫苗10μg,24月龄时检测婴儿HBV表面抗体（HBsAb),以评价母婴HBV阻断效果。结果：（1）研究组胎儿窘迫的发生率为38．3％,对照组为16．5％,两组比较差异有显著性（P＜0．05）。（2）HBV感染胎盘可导致绒毛膜血管病。（3胎儿窘迫者,24月龄时母婴阻断率为78．6％,无胎儿窘迫者母婴HBV阻断率为91．7％,两 者比较,差异有显著性（P＜0．05）。结论：妊娠合并HBV感染,可引起胎盘绒毛膜血管病,致使胎盘功能下降,临床表现为胎儿窘迫、进而导致HBV母婴阻断失败。     

Management of viral hepatitis A,C, D and E in pregnancy

Viral hepatitis can cause significant maternal and neonatal morbidity and mortality. Hepatitis A and E mainly present as acute hepatitis during pregnancy, while hepatitis C and D are usually found as chronic infection in pregnant women. Hepatitis A remains self-limiting during pregnancy while hepatitis E has a higher prevalence and manifests with a rigorous course in pregnant women. Screening of hepatitis C during pregnancy and its subsequent management during pregnancy are still a debatable topic. New treatments of hepatitis C and E require further evaluation for use in pregnancy. This review summarizes the prevalence, clinical manifestations, maternal, foetal and neonatal effects, and the management of hepatitis A, C, D and E viral infection during pregnancy.     

Duration of hepatitis E viremia in pregnancy

Objective

To investigate the duration of hepatitis E virus (HEV) infection in pregnant and non-pregnant women with acute viral hepatitis (AVH) or fulminant hepatic failure (FHF).

Methods

A prospective study conducted with 20 pregnant women with AVH, 20 non-pregnant women with AVH, 10 pregnant women with FHF, and 9 non-pregnant women with FHF—all with HEV infection. The women were followed up on day 7, 15, 30, 60, and 90 following recruitment for the presence of HEV-RNA.

Results

Of the 59 patients with HEV infection, only 2 (3.4%) revealed HEV viremia at day 30 and none of the patients was viremic at day 60 and day 90. The proportion of HEV viremia in pregnant women with AVH and FHF at day 15 was significantly higher than in non-pregnant women (88.3% vs 27.6%; P < 0.001). Similarly, HEV viremia among patients with AVH was significantly higher in pregnant women compared with non-pregnant women (100% vs 55%; P < 0.001).

Conclusion

HEV viremia may be prolonged in pregnancy.     

Routine hepatitis C virus screening in pregnancy: a cost-effectiveness analysis

OBJECTIVE: The purpose of this study was to determine whether routine hepatitis C virus screening in pregnancy is cost-effective. STUDY DESIGN: A decision tree with Markov analysis was developed to compare 3 approaches to asymptomatic hepatitis C virus infection in low-risk pregnant women: (1) no hepatitis C virus screening, (2) hepatitis C virus screening and subsequent treatment for progressive disease, and (3) hepatitis C virus screening, subsequent treatment for progressive disease, and elective cesarean delivery to avert perinatal transmission. Lifetime costs and quality-adjusted life years were evaluated for mother and child. RESULTS: In our base case, hepatitis C virus screening and subsequent treatment of progressive disease was dominated (more costly and less effective) by no screening, with an incremental cost of 108 US dollars and a decreased incremental effectiveness of 0.00011 quality-adjusted life years. When compared with no screening, the marginal cost and effectiveness of screening, treatment, and cesarean delivery was 117 US dollars and 0.00010 quality-adjusted life years, respectively, which yields a cost-effectiveness ratio of 1,170,000 US dollars per quality-adjusted life year. CONCLUSION: The screening of asymptomatic pregnant women for hepatitis C virus infection is not cost-effective.     

乙型肝炎病毒DNA检测在孕期的应用

孕妇血清乙型肝炎病毒(hepatitis B virus, HBV)DNA水平目前被认为是预测发生HBV母婴垂直传播的一个最重要指标和独立的危险因素。普遍认为,在充分考虑对孕妇及胎儿的利与弊的前提下,妊娠中、晚期口服安全性较高的核苷(酸)类抗病毒药物,可在分娩前明显降低母血中HBV DNA载量,从而最大程度地阻断HBV母婴垂直传播。抗病毒治疗4周后监测HBV DNA载量可以预估核苷(酸)类药物抗病毒治疗的远期有效性,以便及时调整治疗方案。HBV DNA检测在孕期的应用与何时应用对阻断HBV母婴垂直传播具有重要意义。     

妊娠期风疹病毒感染对孕妇及胎儿的影响

目的 探讨妊娠期妇女风疹病毒的感染状况及对胎儿的影响。方法 应用酶联免疫吸附方法对1471例孕妇进行风疹病毒IgG,IgM抗体检测;对其中3例引产和死产的胎儿组织及胎盘行组织切片和电子显微镜检查,并用逆逆录-聚合酶链反应（RT-PCR）技术检测风疹病毒核酸。结果 76.1%(1119/1471)的孕妇风疹病毒IgG阳性;7.4%(109/1471)的孕妇风疹病毒IgM阳性,14.1%(208/1471)的孕妇风疹病毒IgG,IgM阴性;2.4%(35/1471)的孕妇风疹病毒IgG,IgM阳性。7例跟踪随访孕妇中,2例出现死胎,1例要求引产;1例引产胎儿的心肌组织细胞和2例死胎的心肌,肝,脑组织细胞及胎盘中均发现风疹病毒颗粒,并经RT-PCR检测到风疹病毒核酸。结论 妊娠期7.4%的孕妇可感染风疹病毒,并导致胎儿宫内感染,造成胎儿不同程度的损伤或严重的先天性风疹综合征。     

妊娠期肝炎病毒多重感染对母婴的影响

目的 探讨妊娠期肝炎病毒多重感染对母婴的影响。方法 对1994年1月至1999年12月在我院产前检查,肝功能异常的孕妇行甲、乙、丙、丁、戊等5种肝炎病毒标记物检测,其中确诊为肝炎病毒多重感染者32例（多重感染组）,确诊为肝炎病毒单一感染者32例（单一感染组）,对两组母儿并发症及预后进行观察比较。结果 两组丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、血清总胆红素（TBIL）水平比较,差异无显著性（P＞0．05）。多重感染组乙型肝炎病毒e抗原（HBeAg)阳性率（35．7％）显著低于单一感染组（76．9％,P＜0．05）,而乙型肝炎病毒e抗体（HBeAb)阳性率（57．1％）显著高于单一感染组（15．4％,P＜0．01）。多重感染组孕妇妊娠高血压综合征（妊高征）、产后出血、重症肝炎、死亡的发生率与单一感染组比较,差异无显著性（P＞0．05）。而多重感染组胎膜早破、早产的发生率（28．1％,25．0％）明显高于单一感染组（6．3％、3．1％,P＜0．05）;胎儿宫内窘迫及新生儿窒息的发生率（31．3％,25．0％）显著高于单一感染组（9．4％、0．0％,P＜0．05、P＜0．01）。结论 妊娠期肝炎病毒多重感染对孕妇的影响无明显加重,而对围产儿的影响较为明显;应加强孕期保健,防止胎膜早破及早产的发生。     

替比夫定对乙肝孕妇T淋巴细胞亚群的影响

目的:分析孕晚期应用替比夫定(Ld T)对乙肝孕妇细胞免疫功能的影响,为降低乙肝高病毒血症孕产妇死亡率提供临床依据。方法:收集2013年3月至12月我院收治的乙肝表面抗原阳性(HBs Ag)阳性、乙肝e抗原(HBe Ag)阳性、HBV DNA≥106IU/ml的59例孕妇,根据孕晚期是否服用Ld T,分为Ld T治疗组和未治疗组。同时收集同期HBs Ag(+)、HBe Ag(-)、HBV DNA106IU/ml的孕妇30例为低病毒组,HBs Ag(-)的孕妇30例为正常对照组。运用流式细胞术分析Ld T对乙肝孕妇外周血CD3~+T细胞、CD4~+T细胞、CD8~+T细胞及CD4+CD25+Treg细胞(Tregs)的影响。结果:正常组、低病毒组、高病毒未治疗组和高病毒Ld T治疗组的CD3~+T细胞比例无明显差异;与正常组比较,高病毒和低病毒组中CD4~+T细胞比例升高、CD8~+T细胞降低、CD4~+/CD8~+比值进一步升高,Tregs比例显著升高。经Ld T治疗后,T细胞亚群基本处于正常水平。与高病毒未治疗组相比,Ld T治疗组的CD4~+T细胞比例下降,CD8~+T细胞比例也有上升趋势,CD4~+/CD8~+比值显著下降,Tregs比例显著降低。结论:乙肝高病毒血症孕妇体内细胞免疫功能紊乱。Ld T治疗可能解除Tregs对乙肝孕妇机体细胞免疫功能的抑制作用,恢复CD4~+T细胞与CD8~+T细胞之间的平衡状态。Ld T治疗可能通过免疫调节在有效阻断母婴垂直传播的同时,还有可能降低重型肝炎发生率,从而降低孕产妇死亡率。     

Burkitt’s lymphoma related to Epstein–Barr virus infection during pregnancy

Setting  Burkitt’s lymphoma is a rare form of cancer and is an extremely rare diagnosis during pregnancy. This form of lymphoma is a very fast growing B cell neoplasm and chemotherapy is the treatment of choice for the disease in all its stages. Case report  The authors describe the case of a Caucasian 40-year-old nulliparous woman, with previous known Epstein–Barr virus infection, that presents at 28 weeks gestation with supraclavicular adenopathy and multiple bilateral breast nodules, in which biopsy showed non-Hodgkin lymphoma, Burkitt’s type. Discussion  There are few described cases of Burkitt’s lymphoma during pregnancy and in general the outcomes have been poor. In most of the cases, the patients were not treated by current standards or instead had a late diagnosis. This neoplasia is the most rapidly progressive human tumor, and any delay in initiating therapy can adversely affect patient’s prognosis. The authors discuss treatment options in pregnancy and its perinatal implications.     

妊娠合并重症肝炎29例临床分析

目的探讨妊娠合并重症肝炎的发病情况与有关围产期正确处理方式，减少对母儿的威胁。方法对我院近8年来29例妊娠合并重症肝炎的病例进行回顾性分析，通过分析其临床表现、病毒标志物、血生化、B超、病理观察、临床处理与妊娠结局，总结对该病的诊治经验和教训。结果急性重症肝炎7例（乙型3例、乙丙重叠感染1例、乙戊重叠感染2例、戊型1例），亚急性重症肝炎11例（乙型7例、戊型1例、病毒阴性3例），慢性重症肝炎11例（乙型10例、病毒阴性1例）。孕产妇预后：治愈2例、好转13例、未愈自动出院5例、死亡9例，死亡率为31．0％。死胎1例，死产2例，新生儿死亡4例，新生儿存活率占69．2％，围产儿死亡率为43．8％。结论妊娠合并重症肝炎严重危及母婴生命安全，是产科严重的合并症之一，定期产前教育和检查及早发现和处理是关键。     

Pattern of hepatitis virus infection among pregnant women and their newborns at the Women's Health Center of Assiut University, Upper Egypt

Objective

To determine the prevalence, risk factors, and rate of vertical transmission of HBV and/or HCV infection among pregnant women in Upper Egypt, and assess the preventive efficacy of administering hepatitis B immunoglobulin and vaccine to newborns on their carrier status at 8 months.

Methods

Five hundred pregnant women were screened for HCV and HBV serum markers by enzyme-linked immunoassay. Those testing positive had their status confirmed by polymerase chain reaction and their levels of liver enzymes and interferon gamma were evaluated. The newborns of HBV-positive women received hepatitis B immunoglobulin and vaccine and were followed up to assess the rates of vertical transmission and carrier status among the newborns.

Results

Of the 500 pregnant women, 6.4% were HCV positive, 4.0% were HBV positive, and 1.0% were both. The vertical transmission rate was 3.1% for HCV, 30.0% for HBV, and 20.0% for a combined infection. The carrier rate of the infants at the end of their eighth month was 10.8% for those with HCV and 8% for those with HBV.

Conclusion

Infection with HBV and/or HCV is highly prevalent among pregnant women in Upper Egypt. The rate of vertical transmission was also high. Administering hepatitis B vaccine and immunoglobulin resulted in a 92% reduction in carrier status among newborns.     

Disseminated gonococcal infection during pregnancy

Background: Disseminated gonococcal infection in pregnancy is rare with the incidence of 0.04–0.09% in pregnant women. Its most common manifestation is arthritis. Case: A 38-year-old woman, G₁P₀, 36⁺ weeks pregnancy came to hospital with decreased fetal movement. She had purulent vaginal discharge and history of self treatment 1 month earlier. She had a fever with arthritis for 3 days. Purulent joint fluid from arthrocentesis of her right wrist demonstrated intracellular Gram negative diplococcal bacteria. The diagnosis was disseminated gonococcal infection. She was successfully treated with parenteral ceftriaxone followed by oral cefixime. Cesarean section was performed due to preterm premature rupture of the membranes. The maternal and neonatal outcomes were uneventful. Conclusion: Disseminated gonococcal infections are not rare, however, disseminated gonococcal infection in pregnancy is a rare condition. Clinicians should be suspicious of the disease when a pregnant patient presents with arthritic symptoms.     

妊娠期妇女弓形体感染对胎婴儿生长发育的影响

目的　探讨妊娠期妇女弓形体 (Tox)感染对胎婴儿生长发育的影响。方法　采用酶联免疫吸附法检测 3 90 8例孕妇外周血中Tox IgM ,对Tox IgM阳性孕妇进一步检测其新生儿脐血中Tox IgM ;应用聚合酶链反应技术检测孕妇流产物中Tox DNA ,其中新生儿脐血Tox IgM或绒毛膜组织中Tox DNA阳性者 95例为感染组 ,阴性者 1 1 9例为非感染组。采用不同监测方法动态观察两组孕妇的妊娠结局和新生儿出生后 3个月及 1 2个月时智力发育状况 ,以及采用早期干预措施后出生 1年及 4年的两组婴幼儿语言IQ、操作IQ及总IQ。结果　感染组孕妇发生流产 1 2例 (1 2 6 % )、死胎 5例(5 3 % )、早产 4例 (4 2 % )、胎儿生长受限 (FGR) 4例 (4 2 % )及畸形 3例 (3 2 % )。非感染孕妇组发生流产 3例 (2 7% )、死胎 1例 (0 9% )、早产 2例 (1 8% )、FGR 2例 (1 8% )及胎儿畸形 1例 (0 9% )。两组比较 ,差异有极显著性 (P <0 0 1 )。感染组的相对危险度 (RR)分别为 :流产 4 7、死胎 5 9、早产 2 3、FGR 2 3及胎儿畸形 3 6。感染组婴幼儿智力发育指数为 93± 1 3 ,运动发育指数为 1 0 1± 1 6。明显低于非感染组的 1 0 7± 1 7和 1 1 1± 1 3 ,两组比较 ,差异有显著性 (P <0 0 5)。采用干预措施后出生 1年及4年 ,感染组婴幼儿语     

Efficacy of peripartum antiviral treatment for hepatic failure due to hepatitis B virus

Objective

To investigate the efficacy of oral nucleosides in preventing hepatic failure during pregnancy (HFP) caused by hepatitis B virus (HBV) infection.

Methods

Besides receiving standard treatment, 70 women with HFP caused by HBV infection joined a study group (n = 40) or a control group (n = 30) according to their preference. In the study group, 14 women were given lamivudine in the third trimester and an antiviral treatment was continued postpartum. The 26 remaining patients were treated postpartum only, with lamivudine (n = 16) or entecavir (n = 10).

Results

In the study group, the values for serum HBV DNA and hepatitis B envelope antigen were markedly lower at 1 and 2 months than they were at baseline (P < 0.001 and P < 0.001, respectively). Moreover, the HBV DNA values at 1 and 2 months were significantly lower in the study than in the control group (P < 0.05). Overall mortality and incidence of intrauterine infection were also significantly lower in the study group (P < 0.05). No newborns had any apparent abnormalities in either group.

Conclusion

Treatment with nucleosides suppressed the replication of HBV DNA and led to biochemical improvement. It also reduced maternal mortality and safely decreased mother-to-child HBV transmission.