妊娠期病毒性肝炎临床特点分析

摘要

目的：了解妊娠期病毒性肝炎的临床特点。方法回顾性分析2009年1月至2013年3月于广州市第八人民医院因病毒性肝炎住院的77例妊娠妇女的临床资料，分析肝炎病因、血清病毒学特点、肝损害程度与孕期的相关性。计量资料的组间比较采用Kruskal－Wallis H检验。结果病因：乙型肝炎多见，共72例（93．51％），有10．27％患者感染甲、乙或戊型肝炎病毒所致急性病毒性肝炎；肝损害程度：中度肝损害64例（83．12％），重度肝损害7例（9．09％），肝衰竭3例（3．90％）；肝炎发作时孕期：妊娠早期16例（20.78％），妊娠中期49例（63．64％），妊娠晚期12例（15．58％）；肝功能指标：总胆汁酸（TBA）、TBil、白蛋白（Alb）、ALT、AST、凝血酶原活动度（PTA）在HBeAg阳性和阴性患者间，以及在HBV DNA＞106 IU/ml和HBV DNA≤106 IU/ml患者间差异均无统计学意义（P＞0．05）。结论妊娠期病毒性肝炎主要由HBV引起，多数引起中度肝损害，重度肝损害或肝衰竭常发生于妊娠中晚期，因此育龄妇女妊娠期须注意防治慢性乙型肝炎。%Objective To study the clinical characteristics of viral hepatitis in pregnancy.Methods A retrospective analysis was per-formed on 77 pregnant women with viral hepatitis who were admitted to our hospital from January 2009 to March 2013.Cause of hepatitis,se-rologic and virologic markers,degree of liver damage,and association with the stage of pregnancy were analyzed.Comparison of continuous data between groups was made by Kruskal-Wallis H test.Results The main cause of viral hepatitis in pregnancy was HBV infection (72 cases,93.51%),and 10.27%of patients were infected with hepatitis A,B or E virus.Moderate liver damage was detected in 64 patients (83.12%),severe liver damage in 7 patients (9.09%),and liver failure in 3 patients (3.90%).Sixteen patients (20.78%)were diag-nosed with hepatitis in the first trimester of pregnancy,49 (63.64%)in the second trimester,and 12 (15.58%)in the third trimester. Liver function indices,including total bile acid (TBA),total bilirubin (TBil),albumin (Alb),alanine aminotransferase (ALT),aspar-tate transaminase (AST),and prothrombin activity (PTA),were compared between HBeAg (+)and HBeAg (-)patients and between patients with HBV DNA >106 IU/ml and ≤106 IU/ml,and no significant differences were found in either comparison (P>0.05).Con-clusion Viral hepatitis in pregnancy is mainly caused by infection with hepatitis B virus.Liver damage is mostly moderate and severe liver damage and liver failure often occur in the middle or late stage of pregnancy.This study indicates that pregnant women should take precau-tions and active treatment for chronic hepatitis B.