CAJ | 학술논문

目的：探讨乙型肝炎病毒（hepatitis B virus，HBV）携带对双胎妊娠结局的影响。方法2004年1月至2012年12月，在南京医科大学鼓楼临床医学院妇产科分娩的双胎妊娠孕妇共569例，其中32例妊娠前乙型肝炎病毒表面抗原（hepatitis B surface antigen，HBsAg）阳性， e抗原阴性且肝功能正常，确诊HBV携带，作为HBsAg阳性组；另外537例孕妇HBsAg阴性，作为HBsAg阴性组。回顾性分析这些孕妇的妊娠结局。采用t检验及χ2检验比较2组间妊娠结局的差异，采用多元线性回归分析探讨影响新生儿出生体重的因素。结果 HBsAg阳性组孕妇发生肝功能损害（妊娠期丙氨酸转氨酶≥50 U/L）的比例明显高于HBsAg阴性组[18.8%（6/32）与5.8%（31/537），χ2=6.367，P=0.012]。HBsAg阳性组孕妇妊娠期糖尿病的发生率高于HBsAg阴性组，但差异无统计学意义[21.9%（7/32）与11.6%（62/537），χ2=2.132，P=0.144]。HBsAg阳性组妊娠期肝内胆汁淤积症、妊娠期高血压疾病、胎膜早破、前置胎盘、胎儿窘迫、产后出血、早产、剖宫产、胎儿脐带绕颈、羊水粪染、新生儿窒息发生率与HBsAg阴性组相比，差异均无统计学意义（P值均>0.05）。多因素分析显示，妊娠期糖尿病（β=67.869，95%CI：0.494~135.244， P=0.048）、孕妇年龄（β=6.592，95%CI：2.020~11.880，P=0.006）和分娩孕周（β=164.069，95%CI：154.426~173.712，P<0.01）对新生儿出生体重均有影响；而孕妇HBsAg阳性对新生儿出生体重的影响无统计学意义（β=78.864，95%CI：-16.950~174.678，P=0.107）。结论 HBV携带者双胎妊娠时易发生肝功能损害，但并不影响其他不良妊娠结局和新生儿疾病的发生风险。
목적：탐토을형간염병독（hepatitis B virus，HBV）휴대대쌍태임신결국적영향。방법2004년1월지2012년12월，재남경의과대학고루림상의학원부산과분면적쌍태임신잉부공569례，기중32례임신전을형간염병독표면항원（hepatitis B surface antigen，HBsAg）양성， e항원음성차간공능정상，학진HBV휴대，작위HBsAg양성조；령외537례잉부HBsAg음성，작위HBsAg음성조。회고성분석저사잉부적임신결국。채용t검험급χ2검험비교2조간임신결국적차이，채용다원선성회귀분석탐토영향신생인출생체중적인소。결과 HBsAg양성조잉부발생간공능손해（임신기병안산전안매≥50 U/L）적비례명현고우HBsAg음성조[18.8%（6/32）여5.8%（31/537），χ2=6.367，P=0.012]。HBsAg양성조잉부임신기당뇨병적발생솔고우HBsAg음성조，단차이무통계학의의[21.9%（7/32）여11.6%（62/537），χ2=2.132，P=0.144]。HBsAg양성조임신기간내담즙어적증、임신기고혈압질병、태막조파、전치태반、태인군박、산후출혈、조산、부궁산、태인제대요경、양수분염、신생인질식발생솔여HBsAg음성조상비，차이균무통계학의의（P치균>0.05）。다인소분석현시，임신기당뇨병（β=67.869，95%CI：0.494~135.244， P=0.048）、잉부년령（β=6.592，95%CI：2.020~11.880，P=0.006）화분면잉주（β=164.069，95%CI：154.426~173.712，P<0.01）대신생인출생체중균유영향；이잉부HBsAg양성대신생인출생체중적영향무통계학의의（β=78.864，95%CI：-16.950~174.678，P=0.107）。결론 HBV휴대자쌍태임신시역발생간공능손해，단병불영향기타불량임신결국화신생인질병적발생풍험。
To investigate the impact of maternal hepatitis B virus (HBV) carrier state on twin pregnancy outcomes. Methods From January 2004 to December 2012, 569 women with twin pregnancy were hospitalized in Nanjing Drum Tower Hospital. Thirty-two women positive for hepatitis B surface antigen (HBsAg)(negative for hepatitis B e antigen, with normal liver function before conception)were included in the HBsAg-positive group and the other 537 women were included in the HBsAg-negative group. The pregnancy outcomes of the two groups were compared by t test and Chi-square test. The risk factors for neonatal birth weight were analyzed by multivariate regression analysis. Results Compared with the HBsAg-negative group, the HBsAg-positive women had a higher incidence of abnormal liver function (alanine aminotransferase≥50 U/L) [18.8% (6/32) vs 5.8% (31/537), χ2=6.367, P=0.012]. The incidence of gestational diabetes mellitus was 21.9% (7/32) in the HBsAg-positive group, which was higher than in the HBsAg-negative group [11.6% (62/537)], although the difference was not significant (χ2=2.132, P=0.144). The incidences of intrahepatic cholestasis of pregnancy,hypertensive disorders complicating pregnancy, premature rupture of membranes, placenta previa, fetal distress, postpartum hemorrhage, preterm birth, caesarean section, umbilical cord around the neck, meconium-staining amniotic fluid and neonatal asphyxia were no statistical difference between two groups (all P<0.05, respectively). Multivariate regression analysis showed that gestational diabetes mellitus (β=67.869, 95%CI: 0.494-135.244, P=0.048), maternal age (β=6.592, 95%CI: 2.020-11.880, P=0.006) and gestational age (β=164.069, 95%CI:154.426-173.712, P<0.01) were risk factors for neonatal birth weight, but not the maternal HBsAg-positive status (β=78.864, 95%CI: -16.950-174.678, P=0.107). Conclusion Twin pregnancy and HBV carrier state increase the risk of abnormal liver function, but not other adverse pregnancy outcomes and newborn diseases.