CAJ | 학술논문

目的：调查昆明地区近10年来孕妇乙型肝炎病毒（hepatitis B virus ， HBV ）携带以及 HBV DNA复制状态与产科结局的关系。方法以2002年5月1日至2011年4月30日10年间在昆明医科大学第一附属医院产科分娩的20854例产妇作为研究对象进行回顾性调查，分析孕妇 HBV感染与某些妊娠不良结局的关系。结果研究期间在本院分娩人数共为20854例，其中 HBV感染770例，总感染率为4．17％；在770例HBV感染中有529例（68．70％）进行HBV DNA检查，其中DNA阳性189例（25．55％）。 HBV 感染且 DNA 阳性组妊娠期糖尿病（gestational diabetes mellitus ，GDM ）发生率（15．87％）显著高于 HBV阴性组（10．70％）（P＜0．05），HBV感染且DNA阳性组妊娠期高血压疾病发生率（7．41％）高于HBV感染但DNA阴性组（2．95％）和 HBV阴性组（3．81％），差异均有统计学意义（P＜0．05）；HBV感染组妊娠期特异性肝病（肝内胆汁淤积症和妊娠期急性脂肪肝）发生率（1．95％）高于HBV阴性组（0．78％）（P＜0．05）。HBV感染组与 HBV阴性组两组间分娩孕周、出生体重，新生儿窒息率、产后出血发生率差异无统计学意义（P＞0．05）。结论母亲 HBV感染或HBV‐DNA病毒复制与GDM 、妊娠期高血压疾病和某些妊娠期特异性肝病发生相关。
목적：조사곤명지구근10년래잉부을형간염병독（hepatitis B virus ， HBV ）휴대이급 HBV DNA복제상태여산과결국적관계。방법이2002년5월1일지2011년4월30일10년간재곤명의과대학제일부속의원산과분면적20854례산부작위연구대상진행회고성조사，분석잉부 HBV감염여모사임신불량결국적관계。결과연구기간재본원분면인수공위20854례，기중 HBV감염770례，총감염솔위4．17％；재770례HBV감염중유529례（68．70％）진행HBV DNA검사，기중DNA양성189례（25．55％）。 HBV 감염차 DNA 양성조임신기당뇨병（gestational diabetes mellitus ，GDM ）발생솔（15．87％）현저고우 HBV음성조（10．70％）（P＜0．05），HBV감염차DNA양성조임신기고혈압질병발생솔（7．41％）고우HBV감염단DNA음성조（2．95％）화 HBV음성조（3．81％），차이균유통계학의의（P＜0．05）；HBV감염조임신기특이성간병（간내담즙어적증화임신기급성지방간）발생솔（1．95％）고우HBV음성조（0．78％）（P＜0．05）。HBV감염조여 HBV음성조량조간분면잉주、출생체중，신생인질식솔、산후출혈발생솔차이무통계학의의（P＞0．05）。결론모친 HBV감염혹HBV‐DNA병독복제여GDM 、임신기고혈압질병화모사임신기특이성간병발생상관。
Objective This study aimed to explore the relationship between maternal HBV infectious status and pregnancy outcomes in Kunming pregnant women over the past 10 years .Method A retrospec‐tive cohort study was conducted on 20 854 consecutive pregnant women who delivered in the 1st Affiliated Hospital of Kunming Medical University from June 2002 to April 2011 .HBV infectious status and preg‐nant outcomes were analyzed among these pregnant women .Results Of the 18 482 pregnant women who had the results of hepatitis B serological determination during the study period ,a total of 770 (4 .17% ) women had HBV infection .Among 770 women ,529 (68 .70% ) completed HBV DNA quantitation and 189(25 .55% ) were positive .The HBV infection and HBV DNA positive cohort had a significantly higher incidence of GDM compared with the HBsAg negative cohort (15 .87% vs 10 .70% ,P<0 .05) ,and preg‐nancy induced hypertension had significantly higher incidence for the women of HBV infection and HBV DNA positive cohort when compared with the HBV infection and HBV DNA negative cohort (7 .41% vs 2 .95% ,P<0 .05) and the HBsAg negative cohort (7 .41% vs 3 .81% ,P<0 .05) .In addition ,the HBV infection cohort had higher incidence of ICP and AFLP compared with the HBsAg negative cohort (1 .95%vs 0 .78% ,P<0 .05) .Gestational age at delivery ,neonatal birth weight ,incidence of neonatal asphyxia and postpartum hemorrhage had no significant difference between the HBV infection cohort and the HBsAg negative cohort .Conclusions Maternal HBV infectious status is associated with the prevalence of GDM ,pregnancy induced hypertention ,ICP and AFLP .