妊娠期病毒性肝炎临床特点分析

目的了解妊娠期病毒性肝炎的临床特点。方法回顾性分析2009年1月至2013年3月于广州市第八人民医院因病毒性肝炎住院的77例妊娠妇女的临床资料,分析肝炎病因、血清病毒学特点、肝损害程度与孕期的相关性。计量资料的组间比较采用Kruskal-Wallis H检验。结果病因:乙型肝炎多见,共72例(93.51%),有10.27%患者感染甲、乙或戊型肝炎病毒所致急性病毒性肝炎;肝损害程度:中度肝损害64例(83.12%),重度肝损害7例(9.09%),肝衰竭3例(3.90%);肝炎发作时孕期:妊娠早期16例(20.78%),妊娠中期49例(63.64%),妊娠晚期12例(15.58%);肝功能指标:总胆汁酸(TBA)、TBil、白蛋白(Alb)、ALT、AST、凝血酶原活动度(PTA)在HBeAg阳性和阴性患者间,以及在HBV DNA106IU/ml和HBV DNA≤106IU/ml患者间差异均无统计学意义(P0.05)。结论妊娠期病毒性肝炎主要由HBV引起,多数引起中度肝损害,重度肝损害或肝衰竭常发生于妊娠中晚期,因此育龄妇女妊娠期须注意防治慢性乙型肝炎。

Analysis of clinical characteristics of viral hepatitis in pregnant women

Objective To study the clinical characteristics of viral hepatitis in pregnancy.Methods A retrospective analysis was per-formed on 77 pregnant women with viral hepatitis who were admitted to our hospital from January 2009 to March 2013.Cause of hepatitis,se-rologic and virologic markers,degree of liver damage,and association with the stage of pregnancy were analyzed.Comparison of continuous data between groups was made by Kruskal-Wallis H test.Results The main cause of viral hepatitis in pregnancy was HBV infection （72 cases,93.51%）,and 10.27%of patients were infected with hepatitis A,B or E virus.Moderate liver damage was detected in 64 patients （83.12%）,severe liver damage in 7 patients （9.09%）,and liver failure in 3 patients （3.90%）.Sixteen patients （20.78%）were diag-nosed with hepatitis in the first trimester of pregnancy,49 （63.64%）in the second trimester,and 12 （15.58%）in the third trimester. Liver function indices,including total bile acid （TBA）,total bilirubin （TBil）,albumin （Alb）,alanine aminotransferase （ALT）,aspar-tate transaminase （AST）,and prothrombin activity （PTA）,were compared between HBeAg （＋）and HBeAg （-）patients and between patients with HBV DNA 〉10^6 IU/ml and ≤10^6 IU/ml,and no significant differences were found in either comparison （P〉0.05）.Con-clusion Viral hepatitis in pregnancy is mainly caused by infection with hepatitis B virus.Liver damage is mostly moderate and severe liver damage and liver failure often occur in the middle or late stage of pregnancy.This study indicates that pregnant women should take precau-tions and active treatment for chronic hepatitis B.