慢性乙型肝炎病毒感染与早产发生风险相关性荟萃分析

摘要

Objective Ascertain the relationship between chronic hepatitis B virus HBV infection and preterm labor . Methods Cohort or case-control studies that discuss the relationship between CHB infection and the risk of preterm labor were searched in PubMed EMBASE CNKI VIP database and WanFang database etc .till March 30 2015 .Data were extracted and analyzed and the quality of the included studies was evaluated both were done independently by two authors .Meta-analysis was performedusingRevMan5.3software.Results 6observationalcase-controlstudiesand35cohort studies involving 23166 CHB-infected women and 2354602 non-infected women were identified .15 of these 41 studies further studied the relationship between preterm labor and CHB-infected women with normal or abnormal liver function .Based on the random-effects meta-analysis the results displayed that the incidence of preterm labor in CHB-infected women was higher than that in women without infection RR=2.13 95%CI 1.75~2.59 P<0.01 .Compared with normal-risk women the incidence of preterm labor of HBV-infected women with normal hepatic function was also higher RR=2.09 95%CI 1.62 ~2.70 P<0.01 .HBV-infected women with hepatic dysfunction had higher incidence of preterm labor than those with normal hepatic function RR=3.20 95%CI 2.56~3.99 P<0.01 . Conlusions CHB-infected women were at higher risk of preterm labor than normal pregnant women and further hepatic dysfunction would lead to a continuing increase of the risk .Therefore it is of great significance to screen for HBV infection during pregnancy and monitor liver function if the results are positive .%目的：评价慢性乙型肝炎病毒（ HBV ）感染孕妇早产发生的风险，为临床应用提供证据。方法通过计算机检索 PubMed、 Embase、中国学术期刊全文数据库（ CNKI）、重庆维普中文期刊全文数据库、万方科技期刊全文数据库等数据库，检索2015年3月30日前有关慢性HBV感染孕妇早产发生风险的文献，提取相关文献的原始数据，对纳入研究的文献进行质量评价，采用RevMan 5．3软件进行荟萃分析，文献数据提取、质量评价以及数据分析皆由两名评价员分别独立进行。结果最终纳入文献41篇，包括6篇病例对照研究和35篇队列研究，其中15篇文献对HBV感染孕妇按照肝功能正常与否进行分组，进一步研究肝功能正常与否的HBV感染孕妇早产的发生风险。本荟萃分析纳入慢性乙型肝炎感染孕妇合计23166例，同期正常孕妇合计2354602例。（1） HBV感染孕妇早产发生风险比较：与正常孕妇相比， HBV感染孕妇早产发生风险更高，差异有统计学意义（ RR＝2．13，95％CI为1．75～2．59， P＜0．01）；（2）肝功能正常HBV感染孕妇早产发生风险比较：与正常孕妇相比，肝功能正常的 HBV 感染孕妇早产发生风险更高，差异有统计学意义（RR＝2．09，95％CI为1．62～2．70， P＜0．01）；（3）肝功能异常HBV感染孕妇与肝功能正常HBV感染孕妇早产发生风险比较：与肝功能正常HBV感染孕妇相比，肝功能异常HBV感染孕妇早产发生风险更高，差异有统计学意义（ RR＝3．20，95％CI为2．56～3．99， P＜0．01）结论慢性乙型肝炎病毒感染孕妇早产发生风险显著高于正常孕妇，而且慢性乙型肝炎合并肝功能异常孕妇早产发生风险将进一步增大。因此，实施产前HBV感染检查并监测肝功能变化可能具有重要意义。