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。

Analysis of fetal distress in pregnancy with hepatitis B virus infection

OBJECTIVE: To investigate the cause, prognosis and the treatment of fetal distress in pregnant women with hepatitis B virus (HBV) infection. METHODS: eighty one pregnant women and their newborns were selected. The HBV surface antigen (HBsAg), e antigen (HBeAg), core antibody (HBcAb) and deoxyribonucleic acid (HBV DNA) was positive and the hepatic function normal. eighty five pregnant women without HBV infection, normal hepatic function and their newborns were collected as control. The clinical data, serology examination, placenta histological examination and fetal prognosis of the two groups was analysed 76 infants of the investigation group were vaccinated hepatitis B vaccine 10 microgram at 0, 1 and 6 month respectively. Infant's hepatitis B surface antibody (HBsAb) was detected at 24 month. RESULTS: (1) The incidence of the fetal distress in investigation group was 38.3, %, in the control group was 16.5% (P < 0.05). (2) The main reason was chorion angiopathy induced by HBV infection of placenta. (3) In infants with fetal distress, the block rate from mother to fetus was 78.6%, for the infants without distress was 91.7% (P < 0.05). CONCLUSION: HBV infection during pregnancy may cause placenta chorion angiopathy, reduce placenta function, lead to fetal distress and result in immunization failure.