代谢综合征对慢性HBV感染孕妇母婴结局的影响

目的探讨代谢综合征（MS）对HBV感染孕妇母婴结局的影响。 方法选择2011年7月至2014年7月于本院规律产检孕妇1 200例,分为H组（慢性HBV感染孕妇640例）及NH组（非HBV感染孕妇（无HBV及HCV感染560例）,根据有无MS再分为H-M组（89例）、H-NM组（551例）、NH-M组（36例）及NH-HM（524例）。回顾性分析发生MS与不发生MS孕妇的母婴结局。 结果H组患者MS的发生率（13.91%）高于NH组（4.64%）（χ²= 4.912、P = 0.027）,平均孕前体重指数、孕期平均空腹血糖、平均餐后2 h血糖、孕期平均收缩压、平均舒张压、平均病毒载量、终止妊娠孕周,H-M组与H-NM组相比差异均具有统计学意义（P均<0.05）。妊娠期高血压疾病、妊娠期糖尿病、羊水过多、胎膜早破、妊娠期肝内胆汁淤积症、肝功能异常、剖宫产、阴道助产、产后出血、会阴裂伤和切口愈合不良等妊娠并发症的发生率,H-M组患者均显著高于H-NM组,NH-M组患者均显著高于NH-NM组,H组患者显著高于NH组,H-M组显著高于NH-M组,差异均具有统计学意义（P均<0.05）。新生儿结局胎儿窘迫、早产儿、低出生体重儿、巨大儿、新生儿低血糖、新生儿窒息的发生率方面,H-M组显著高于H-NM组,NH-M组高于NH-NM组,H组高于NH组,H-M组高于NH-M组,差异均具有统计学意义（P均<0.05）。H-M组新生儿HBV感染率高于H-NM组（χ²= 4.646,P = 0.024）。 结论HBV感染孕妇较正常孕妇更易发生代谢综合征,且代谢综合征合并HBV感染者更易发生不良母婴结局,代谢综合征会影响孕期HBV病毒的复制以及母婴阻断的效果,应重视代谢综合征在HBV感染孕妇中的早期诊断、干预及预防。

Influence of metabolic syndrome on maternal and fetal outcomes of women with chronic HBV infection

ObjectiveTo investigate the influence of metabolic syndrome on maternal and fetal outcomes of pregnant women with chronic HBV infection. MethodsTotal of 1 200 pregnant women were enrolled between July 2010 and July 2014. There were 640 women with chronic HBV infection were defined as HBV infection group (H group). Another 560 women without chronic HBV infection were defined as non-HBV infection group (NH group); 89 women with metabolic syndrome in HG group were defined as H-M group (H-M group); 551 women without metabolic syndrome in HG group were defined as H-NM group (H-NM group); 36 women with metabolic syndrome in NH group were defined as NH-M group (NH-M group); 524 women without metabolic syndrome in NH group were defined as NH-NM group (NH-NM group). Maternal and fetal outcomes of women in the groups were analyzed, retrospectively. ResultsThe prevalence of MS in H group was 13.91% and significantly different from that of the NH group which was 4.64% (χ²= 4.912, P = 0.027). The BMI, FBG, PBG, systolic blood pressure, diastolic blood pressure and mean HBV DNA copies, delivery time in H-M group were significantly different compared with those of H-NM group (P all < 0.05). The incidence rate of the pregnant hypertension syndrome, gestational dibetes melliums, polyhydramnios, premature rupture of membranes, intrahepatic cholestasis of pregnancy, dysfunction of liver, the cesarean section, the vaginal midwifery, immediate postpartum hemorrhage, the perinea laceration, poor wound healing in H-M group were significantly different compared with those of H-NM group (P all < 0.05). The statistical differences of these indexes were also found between NH-M group and NH-NM group, between H goup and NH group, between H-MG and NH-MG (P all < 0.05). The incidence rates of adverse fatal outcomes: fetal distress, preterm infant, low birth weight infant, fatal macrosomia, neonatal hypoglycemia, neonatal asphyxia, in H-M group were significantly different compared to those of H-NM group. The statistical differences of these indexes were also found between NH-M group and NH-NM group, between H group and NH group, between H-M group and NH-M group. HBV infection rate of newborn in H-M group was significantly different compared to that in H-NM group (χ²= 4.646, P = 0.024). ConclusionsThe coexistence of HBV infection and metabolic syndrome in pregnanct women could induce more adverse pregnancy complications and fetal outcomes. Metabolic syndrome can influence the replication of HBV. Early diagnosis, prevent and intervension of the metabolic syndrome in pregnancy women with HBV infection should be strengthened.