妊娠合并病毒性肝炎患者体液免疫功能的变化及临床意义

目的:探讨妊娠合并病毒性肝炎患者体液免疫变化的特点及其临床意义。方法:采用速率散色比浊法和速率法检测120例妊娠期合并病毒性肝炎患者和100例正常孕妇血清免疫球蛋白、血清补体C3、C4和胆汁酸水平,并观察其与母婴并发症和妊娠结局的关系。结果:①妊娠合并病毒性肝炎组IgG水平为(8.31±2.11)g/L,显著低于正常妊娠组(10.1±1.87)g/L(P<0.05),IgM水平为(2.66±0.91)g/L,明显高于正常妊娠组(1.61±0.81)g/L(P<0.05);②妊娠合并病毒性肝炎患者血清IgG和IgM水平分别与体内胆汁酸浓度(49.99±36.1)μmol/L呈负相关和正相关,相关系数(!)分别为-0.512和0.327(P<0.05);③如将95%正常妊娠妇女体液免疫数值作为正常值范围,把妊娠合并病毒性肝炎患者分为体液免疫异常组和正常组,则异常组流产、胎儿宫内窘迫、早产及围生儿死亡率明显增高。结论:大部分妊娠合并病毒性肝炎患者的部分体免疫功能发生了改变,其异常程度与围生期母婴结局明显相关。

The changes of humoral immunity in pregnancy complicated with viral hepatitis and its clinical significance

Objective To study the characteristic and clinical significance of the changes of humoral immunity in intrahepatic cholestasis of pregnancy. Method The concentrations of serum immunoglobulinA(IgA),immunoglobulinM(IgM),immunoglobulinG(IgG),complement3(C3),complement4(C4),and total bile acid were measured in 120 cases of pregnancy complicated with viral hepatitis and 100 cases of normal pregnant women.The relationships between the serum IgA, IgM, IgG, C3 ,C4 concentrations and the complications of mother and new-born in ICP were analysed. Results ①The level of IgG which was (8.31±2.11)g/L in pregnancy complicated with viral hepatitis group was significantly lower than that of (10.1±1.87)g/L in normal pregnancy group(P<0.05).The level of IgM which was (2.66±0.91)g/L in pregnancy complicated with viral hepatitis group was significantly higher than that of (1.61±0.81)g/L in normal pregnancy group(P<0.05).②There were negative correlation between total bile acid and IgG,and positive correlation between total bile acid and IgM,the correlation coefficients (r) were -0.512 and 0.327,respectively(P<0.05). ③If the humoral immunity values of 95% in normal pregnant women were taken as the normal ranges ,and the pregnancy complicated with viral hepatitis cases were divided into normal and abnormal humoral immunity groups,the occurrences of meconium stained amnionic fluid,fetal distress,premature delivery,and prenatal death were significantly increased in the latter group. Conclusion The humoral immunity in pregnancy complicated with viral hepatitis takes changes partly.There is significant correlation between the abnormal humoral immunity and the perinatal complications of mother and new-born.