妊娠合并乙型肝炎病毒感染对母婴的影响

目的 :探讨妊娠合并乙型肝炎病毒感染对母婴的影响及影响因素。方法 :1999年1月～2003年1月我院产前门诊筛选乙型肝炎病毒表面抗原(HBsAg)阳性的孕妇206例为研究对象 ,根据乙肝血清学测定分为3组 :大三阳组 :其中HBsAg、乙型肝炎e病毒抗原(HBeAg)、乙型肝炎病毒核心抗体(anti-HBc)均阳性 ,共41例 ;小三阳组 :HBsAg、anti-HBe、anti-HBc均阳性 ,共67例 ;携带组 :仅HBsAg阳性 ,共98例。并随机抽取同期健康且无合并症的孕妇100例作对照组。比较各组孕妇发生胎膜早破、早产、妊高征、胎儿窘迫、肝功能损害、产后出血发生率及围生儿结局。结果 :妊娠期乙肝感染大三阳组、小三阳组胎膜早破、早产、肝功能损害、产后出血、低体重儿、新生儿窒息发生率与正常对照组比较均有显著差异 ,而大三阳组较小三阳组差异更为显著 (P<0.01)。携带组除产后出血率外与正常对照组无明显差异(P>0.05)。结论 :孕妇无症状的HBV感染 ,特别是大三阳、小三阳 ,可造成不良妊娠结局。应加强对这些孕妇的孕期监护 ,并积极防治早产、产后出血等的发生。

Study on the influence of pregnancy with hepatitis B virus infection on mother and infant

Objective:To study the influence of pregnancy with hepatitis B virus(HBV) infection on mother and infant and its influence factors.Methods:206 gravidas with hepatitis B surface antigen(HBsAg) positivity from January 1999 to January 2003 selected in our department were served as research object,and divided into three groups according to their results of hepatitis B serological determination.In which all BHsAg,hepatitis B e antigen(HBeAg) and hepatitis B core antibody(anti-HBc) in 41 cases were positive in large three-positive group,HBsAg,hepatitis B e antibody(anti-HBe) and anti-HBc in 67 cases were also positive in small three-positive group,only HBsAg in 98 cases was positive in carrier group.100 healthy gravidas without complication were selected randomly to serve as a control group at the same time.The occurrence rates of rupture of fetal membranes,premature labor,pregnancy-induced hypertension syndrome,fetal distress,liver function damage,postpartum hemorrhage and perinatal outcome were compared among them.Results:There were significant differences in the occurrence rates of rupture of fetal membralnes,premature labor,liver function damage,postpartum hemorrhage,low birth weight infant and asphyxia neonatorum between large three-positive group,small three-positive group and normal control group,especially large three-positive group was even significant compared with the small three-positive group(P<0.01).Apart from the rate of postpartum hemorrhage,there was no significant difference between carrier group and normal control group(P>0.05).Conclusion:HBV infection in the gravidas without complication may cause unfortunate outcome of pregnancy,especially large three-positive and small three-positive cases.It is very important to strengthen the pregnant monitoring,prevent and treat the occurrence of premature labor,postpartum hemorrhage and so on.