CAJ | 학술논문

目的：探讨妊娠妇女乙型肝炎病毒（HBV）感染的肝功能、病毒学特点。方法对我院HBV感染的孕妇共259例资料进行回顾性分析，与60例慢性HBV感染未妊娠妇女相比较。用电化学发光法检测乙型肝炎两对半定量、荧光定量PCR法检测HBV DNA定量。结果33.98%患者有HBV感染的家族史；非妊娠妇女的ALT、AST水平均较妊娠妇女明显升高；71.81% HBV感染的妊娠妇女肝功能正常，慢性乙型肝炎重度7例（2.70%）；慢性乙型肝炎重型3例（1.16%）；59.85%患者HBeAg（＋），HBV DNA水平＞5 log10 IU/ml患者63.71%，HBeAg阳性组孕妇的ALT、AST水平、HBV DNA定量较阴性组患者明显升高；HBeAg阳性组孕妇中，随着HBV DNA水平升高，ALT水平明显升高伴统计学意义，HBeAg阴性组孕妇中，随着HBV DNA水平升高，ALT、AST水平亦明显升高伴统计学意义；HBV DNA定量＞5 log10 IU/ml妊娠妇女中高达46.06%ALT、AST水平升高。HBeAg阳性比例小于28岁的年轻孕妇（65.49%）显著高于年长孕妇（52.99%），28岁以上的年长孕妇发生肝功能损害发生率（34.19%）显著高于年轻孕妇（20.42%）。结论妊娠妇女HBV感染患者以HBeAg（＋）为主，占59.85%，HBV DNA水平＞5 log10 IU/ml者为多，占63.71%；71.81%患者肝功能正常；HBeAg阳性孕妇，肝功能异常较阴性患者明显，HBV DNA水平亦明显升高；无论是HBeAg阳性还是阴性患者，随着HBV DNA水平的升高，更容易出现肝损害；HBV DNA定量＞5 log10 IU/ml 妊娠妇女中46.06%肝功能异常。28岁以下年轻孕妇HBeAg阳性率65.49%高于年长孕妇，但肝功能异常率20.42%，低于年长孕妇。因此对HBV感染的孕妇需要密切观察肝功能、HBV DNA、HBeAg水平，特别是HBeAg阳性和HBV DNA水平较高的妊娠妇女需要警惕肝炎活动。建议HBV感染的女性28岁以前妊娠减少肝功能损害的风险。孕妇HBV感染的临床特征与母婴传播阻断的关系有待进一步探讨。目的：探討妊娠婦女乙型肝炎病毒（HBV）感染的肝功能、病毒學特點。方法對我院HBV感染的孕婦共259例資料進行迴顧性分析，與60例慢性HBV感染未妊娠婦女相比較。用電化學髮光法檢測乙型肝炎兩對半定量、熒光定量PCR法檢測HBV DNA定量。結果33.98%患者有HBV感染的傢族史；非妊娠婦女的ALT、AST水平均較妊娠婦女明顯升高；71.81% HBV感染的妊娠婦女肝功能正常，慢性乙型肝炎重度7例（2.70%）；慢性乙型肝炎重型3例（1.16%）；59.85%患者HBeAg（＋），HBV DNA水平＞5 log10 IU/ml患者63.71%，HBeAg暘性組孕婦的ALT、AST水平、HBV DNA定量較陰性組患者明顯升高；HBeAg暘性組孕婦中，隨著HBV DNA水平升高，ALT水平明顯升高伴統計學意義，HBeAg陰性組孕婦中，隨著HBV DNA水平升高，ALT、AST水平亦明顯升高伴統計學意義；HBV DNA定量＞5 log10 IU/ml妊娠婦女中高達46.06%ALT、AST水平升高。HBeAg暘性比例小于28歲的年輕孕婦（65.49%）顯著高于年長孕婦（52.99%），28歲以上的年長孕婦髮生肝功能損害髮生率（34.19%）顯著高于年輕孕婦（20.42%）。結論妊娠婦女HBV感染患者以HBeAg（＋）為主，佔59.85%，HBV DNA水平＞5 log10 IU/ml者為多，佔63.71%；71.81%患者肝功能正常；HBeAg暘性孕婦，肝功能異常較陰性患者明顯，HBV DNA水平亦明顯升高；無論是HBeAg暘性還是陰性患者，隨著HBV DNA水平的升高，更容易齣現肝損害；HBV DNA定量＞5 log10 IU/ml 妊娠婦女中46.06%肝功能異常。28歲以下年輕孕婦HBeAg暘性率65.49%高于年長孕婦，但肝功能異常率20.42%，低于年長孕婦。因此對HBV感染的孕婦需要密切觀察肝功能、HBV DNA、HBeAg水平，特彆是HBeAg暘性和HBV DNA水平較高的妊娠婦女需要警惕肝炎活動。建議HBV感染的女性28歲以前妊娠減少肝功能損害的風險。孕婦HBV感染的臨床特徵與母嬰傳播阻斷的關繫有待進一步探討。
목적：탐토임신부녀을형간염병독（HBV）감염적간공능、병독학특점。방법대아원HBV감염적잉부공259례자료진행회고성분석，여60례만성HBV감염미임신부녀상비교。용전화학발광법검측을형간염량대반정량、형광정량PCR법검측HBV DNA정량。결과33.98%환자유HBV감염적가족사；비임신부녀적ALT、AST수평균교임신부녀명현승고；71.81% HBV감염적임신부녀간공능정상，만성을형간염중도7례（2.70%）；만성을형간염중형3례（1.16%）；59.85%환자HBeAg（＋），HBV DNA수평＞5 log10 IU/ml환자63.71%，HBeAg양성조잉부적ALT、AST수평、HBV DNA정량교음성조환자명현승고；HBeAg양성조잉부중，수착HBV DNA수평승고，ALT수평명현승고반통계학의의，HBeAg음성조잉부중，수착HBV DNA수평승고，ALT、AST수평역명현승고반통계학의의；HBV DNA정량＞5 log10 IU/ml임신부녀중고체46.06%ALT、AST수평승고。HBeAg양성비례소우28세적년경잉부（65.49%）현저고우년장잉부（52.99%），28세이상적년장잉부발생간공능손해발생솔（34.19%）현저고우년경잉부（20.42%）。결론임신부녀HBV감염환자이HBeAg（＋）위주，점59.85%，HBV DNA수평＞5 log10 IU/ml자위다，점63.71%；71.81%환자간공능정상；HBeAg양성잉부，간공능이상교음성환자명현，HBV DNA수평역명현승고；무론시HBeAg양성환시음성환자，수착HBV DNA수평적승고，경용역출현간손해；HBV DNA정량＞5 log10 IU/ml 임신부녀중46.06%간공능이상。28세이하년경잉부HBeAg양성솔65.49%고우년장잉부，단간공능이상솔20.42%，저우년장잉부。인차대HBV감염적잉부수요밀절관찰간공능、HBV DNA、HBeAg수평，특별시HBeAg양성화HBV DNA수평교고적임신부녀수요경척간염활동。건의HBV감염적녀성28세이전임신감소간공능손해적풍험。잉부HBV감염적림상특정여모영전파조단적관계유대진일보탐토。
Objective To study liver function and virus features of the pregnant women with hepatitis B virus (HBV) infection. Methods 259 pregnant women with HBV infection in our hospital were retrospectively analyzed, and compared with 60 non-pregnant women with chronic HBV infection. HBV serological markers were examined by electrochemiluminescence. HBV DNA levels were detected by fluorescent quantitative PCR. Results 33.98%of the patients had family history with HBV infection. ALT and AST were much higher in non-pregnant women than in pregnant women. The liver function was normal in 71.81%of the pregnant women with HBV infection, including 7 cases (2.70%) with chronic severe hepatitis B and 3 cases (1.16%) with liver failure. 59.85%of the patients were HBeAg positive and 63.71%of the patients were with HBV DNA>5 log10 IU/ml. ALT, AST and HBV DNA levels were much higher in HBeAg+ pregnant women than in HBeAg-pregnant women. In HBeAg+pregnant women, ALT increased significantly with the increased HBV DNA levels. In HBeAg-pregnant women, ALT and AST were in the same situation. And the proportion of ALT and AST increased was 46.06% in the pregnant women with HBV DNA level>5 log10 IU/ml. The HBeAg positive rate (65.49%) was significantly higher in less than 28 years old young pregnant women than the older pregnant women(52.99%), while the liver function damage rate (20.42%)was lower than that of the older women(34.19%). Conclusions Pregnant women were characterized by HBeAg+ (59.85%) and HBV DNA>5 log10 IU/ml(63.71%). 71.81%of the patients were with normal liver function. In HBeAg positive pregnant women, abnormal liver function were more serious than in HBeAg negative pregnant women, and HBV DNA levels significantly increased. Whether HBeAg positive or negative, with the increased HBV DNA levels, liver damages were more often. Liver function was abnormal in 46.06%pregnant women with HBV DNA levels>5 log10 IU/ml. In less than 28 years old young pregnant women the HBeAg positive rate (65.49%) was significantly higher than the older pregnant women, but the liver function damage rate (20.42%) reduced. Therefore the pregnant women with HBV infection should be closely observed by liver function, HBV DNA levels, HBeAg levels. Especially hepatitis should by prevented in the pregnant women with positive HBeAg and high HBV DNA levels. If pregnant before 28 years old for the women infected with HBV, the liver function damage will be reduced. The relationship of clinical features of the pregnant women with hepatitis B virus (HBV) infection and Mother to child transmission blocking needs further research.