慢性HBV感染者妊娠期糖尿病对母婴结局的影响
|
摘要
关于妊娠期慢性HBV感染与妊娠期糖尿病(GDM)之间关系的研究较少,且结论不一致。2018年一项包含23个队列研究的荟萃分析中,发现妊娠期HBsAg阳性的孕妇发生GDM的风险更高,而且在不同的地理区域和研究人群中的结论是一致的。虽然研究证实HBV感染与GDM之间存在相关性,但其潜在机制尚不清楚。分析了慢性HBV感染造成GDM发生的可能机制,探讨了慢性HBV感染对GDM母婴结局的影响,提出了"全面二孩"政策实施后HBV感染妇女带来的挑战,如何加强慢性HBV感染妊娠期母体和新生儿的监控,减少母婴各类并发症仍是医务工作者努力的目标。
There are relatively few studies on the association between chronic hepatitis B virus( HBV) infection during pregnancy and gestational diabetes mellitus( GDM),with inconsistent conclusions. A meta-analysis of 23 cohort studies conducted in 2018 showed that HBs Ag-positive pregnant women had a higher risk of GDM,which was consistent across the populations from different geographical regions and studies. Although studies have confirmed the association between HBV infection and GDM,the underlying mechanism remains unclear. This article analyzes the possible mechanism of GDM caused by HBV infection,investigates the influence of chronic HBV infection on maternal and neonatal outcomes of women with GDM,and discusses the challenge for women with HBV infection after the implementation of the"universal two-child policy". It is still a goal for medical workers to strengthen the monitoring of pregnant women with chronic HBV infection and neonates and reduce the complications of mothers and neonates.
There are relatively few studies on the association between chronic hepatitis B virus( HBV) infection during pregnancy and gestational diabetes mellitus( GDM),with inconsistent conclusions. A meta-analysis of 23 cohort studies conducted in 2018 showed that HBs Ag-positive pregnant women had a higher risk of GDM,which was consistent across the populations from different geographical regions and studies. Although studies have confirmed the association between HBV infection and GDM,the underlying mechanism remains unclear. This article analyzes the possible mechanism of GDM caused by HBV infection,investigates the influence of chronic HBV infection on maternal and neonatal outcomes of women with GDM,and discusses the challenge for women with HBV infection after the implementation of the"universal two-child policy". It is still a goal for medical workers to strengthen the monitoring of pregnant women with chronic HBV infection and neonates and reduce the complications of mothers and neonates.
引文
[1]OTT JJ,STEVENS GA,GROEGER J,et al.Global epidemiology of hepatitis B virus infection:New estimates of age-specific HBsAg seroprevalence and endemicity[J].Vaccine,2012,30(12):2212-2219.
[2]SHI G,ZHANG SX.Meta-analysis on the positive rate of hepatitis B surface antigen among pregnant women in China[J].Chin Prevent Med,2013,14(1):26-30.(in Chinese)石果,张顺祥.我国孕妇乙肝表面抗原阳性率的Meta分析[J].中国预防医学杂志,2013,14(1):26-30.
[3]KWAN LC,HO YY,LEE SS.The declining HBsAg carriage rate in pregnant women in Hong Kong[J].Epidemiol Infect,1997,119(2):281-283.
[4]FRAMBO AA,ATASHILI J,FON PN,et al.Prevalence of HB-sAg and knowledge about hepatitis B in pregnancy in the Buea Health District,Cameroon:A cross-sectional study[J].BMCRes Notes,2014,7:394.
[5]TAN J,LIU X,MAO X,et al.HBsAg positivity during pregnancy and adverse maternal outcomes:A retrospective cohort analysis[J].J Viral Hepat,2016,23(10):812-819.
[6]LIU J,ZHANG S,LIU M,et al.Maternal pre-pregnancy infection with hepatitis B virus and the risk of preterm birth:Apopulation-based cohort study[J].Lancet Glob Health,2017,5(6):e624-e632.
[7]CUI AM,CHENG XY,SHAO JG,et al.Maternal hepatitis B virus carrier status and pregnancy outcomes:A prospective cohort study[J].BMC Pregnancy Childbirth,2016,16:87.
[8]WONG S,CHAN LY,YU V,et al.Hepatitis B carrier and perinatal outcome in singleton pregnancy[J].Am J Perinatol,1999,16(9):485-488.
[9]CONNELL LE,SALIHU HM,SALEMI JL,et al.Maternal hepatitis B and hepatitis C carrier status and perinatal outcomes[J].Liver Int,2011,31(8):1163-1170.
[10]CHEN J,ZHANG S,ZHOU YH,et al.Minimal adverse influence of maternal hepatitis B carrier status on perinatal outcomes and child’s growth[J].J Matern Fetal Neonatal Med,2015,28(18):2192-2196.
[11]CHANG CY,AZIZ N,POONGKUNRAN M,et al.Serum aminotransferase flares in pregnant and postpartum women with current or prior treatment for chronic hepatitis B[J].J Clin Gastroenterol,2018,52(3):255-261.
[12]ZHUANG X,CUI AM,WANG Q,et al.Liver dysfunction during pregnancy and its association of with preterm birth in China:A prospective cohort study[J].EBio Medicine,2017,26:152-156.
[13]CUNDY T,ACKERMANN E,RYAN EA.Gestational diabetes:New criteria may triple the prevalence but effect on outcomes is unclear[J].BMJ,2014,348:g1567.
[14]KONG D,LIU H,WEI S,et al.A meta-analysis of the association between gestational diabetes mellitus and chronic hepatitis B infection during pregnancy[J].BMC Res Notes,2014,7:139.
[15]LAO TT,TSE KY,CHAN LY,et al.HBsAg carrier status and the association between gestational diabetes with increased serum ferritin concentration in Chinese women[J].Diabetes Care,2003,26(11):3011-3016.
[16]TO WW,CHEUNG W,MOK KM.Hepatitis B surface antigen carrier status and its correlation to gestational hypertension[J].Aust N Z J Obstet Gynaecol,2003,43(2):119-122.
[17]TSE KY,HO LH,LAO T.The impact of maternal HBs Ag carrier status on pregnancy outcomes:A case-control study[J].J Hepatol,2005,43(5):771-775.
[18]LAO TT,CHAN BC,LEUNG WC,et al.Maternal hepatitis Binfection and gestational diabetes mellitus[J].J Hepatol,2007,47(1):46-50.
[19]LAO TT,CHUNG MK,CHEUNG TK,et al.Antenatal hepatitis B and increased risk of gestational diabetes mellitus-Implications for obstetric care[J].J Infect,2016,72(5):625-626.
[20]SAFIR A,LEVY A,SIKULER E,et al.Maternal hepatitis B virus or hepatitis C virus carrier status as an independent risk factor for adverse perinatal outcome[J].Liver Int,2010,30(5):765-770.
[21]REDDICK KL,JHAVERI R,GANDHI M,et al.Pregnancy outcomes associated with viral hepatitis[J].J Viral Hepat,2011,18(7):e394-e398.
[22]LAO TT,SAHOTA DS,CHENG YK,et al.Maternal hepatitis Bsurface antigen status and incidence of pre-eclampsia[J].JViral Hepat,2013,20(5):343-349.
[23]TAN J,MAO X,ZHANG G,et al.Hepatitis B surface antigen positivity during pregnancy and risk of gestational diabetes mellitus:A systematic review and meta-analysis[J].J Viral Hepat,2018,25(11):1372-1383.
[24]MAGHBOOLI Z,HOSSEIN-NEZHAD A,RAHMANI M,et al.Relationship between leptin concentration and insulin resistance[J].Honn Metab Res,2007,39(12):903-907.
[25]MURAKAMI S.Hepatitis B virus X protein:Structure,function and biology[J].Intervirology,1999,42(2-3):81-99.
[26]WINKLER G,CSEH K,BARANYI E,et al.Tumour necrosis factor system in insulin resistance in gestational diabetes[J].Diabetes Res Clin Pract,2002,56(2):93-99.
[27]BOZKAYA H,BOZDAYI M,TURKYILMAZ R,et al.Circulating IL-2,IL-10 and TNF-alpha in chronic hepatitis B:Their relations to HBe Ag status and the activity of liver disease[J].Hepatogastroenterology,2000,47(36):1675-1679.
[28]LEE JG,LEE S,KIM YJ,et al.Association of chronic viral hepatitis B with insulin resistance[J].World J Gastroenterol,2012,18(42):6120-6126.
[29]WANG J,LU W,LI J,et al.Hemodynamic effects of reninangiotensin-aldosterone inhibitor andβ-blocker combination therapy vs.β-blocker monotherapy for portal hypertension in cirrhosis:A meta-analysis[J].Exp Ther Med,2017,13(5):1977-1985.
[30]MA X,SUN D,LI C,et al.Chronic hepatitis B virus infection and preterm labor(birth)in pregnant women-an updated systematic review and meta-analysis[J].J Med Virol,2018,90(1):93-100.
[31]CHENG L,YANG XH,HU JN.Clinical features and management strategies of re-pregnant women with chronic hepatitis B virus infection after implementation of"two-child policy"[J].Chin JClin Infect Dis,2017,10(3):181-186.(in Chinese)程丽,杨小红,胡健女.“全面二孩”后合并慢性乙型肝炎病毒感染再妊娠妇女临床特点分析[J].中华临床感染病杂志,2017,10(3):181-186.
[32]XIN X,WANG Y,CHENG J,et al.Seroepidemiological survey of hepatitis B virus infection among 764,460 women of childbearing age in rural China:A cross-sectional study[J].JClin Virol,2016,81:47-52.
[2]SHI G,ZHANG SX.Meta-analysis on the positive rate of hepatitis B surface antigen among pregnant women in China[J].Chin Prevent Med,2013,14(1):26-30.(in Chinese)石果,张顺祥.我国孕妇乙肝表面抗原阳性率的Meta分析[J].中国预防医学杂志,2013,14(1):26-30.
[3]KWAN LC,HO YY,LEE SS.The declining HBsAg carriage rate in pregnant women in Hong Kong[J].Epidemiol Infect,1997,119(2):281-283.
[4]FRAMBO AA,ATASHILI J,FON PN,et al.Prevalence of HB-sAg and knowledge about hepatitis B in pregnancy in the Buea Health District,Cameroon:A cross-sectional study[J].BMCRes Notes,2014,7:394.
[5]TAN J,LIU X,MAO X,et al.HBsAg positivity during pregnancy and adverse maternal outcomes:A retrospective cohort analysis[J].J Viral Hepat,2016,23(10):812-819.
[6]LIU J,ZHANG S,LIU M,et al.Maternal pre-pregnancy infection with hepatitis B virus and the risk of preterm birth:Apopulation-based cohort study[J].Lancet Glob Health,2017,5(6):e624-e632.
[7]CUI AM,CHENG XY,SHAO JG,et al.Maternal hepatitis B virus carrier status and pregnancy outcomes:A prospective cohort study[J].BMC Pregnancy Childbirth,2016,16:87.
[8]WONG S,CHAN LY,YU V,et al.Hepatitis B carrier and perinatal outcome in singleton pregnancy[J].Am J Perinatol,1999,16(9):485-488.
[9]CONNELL LE,SALIHU HM,SALEMI JL,et al.Maternal hepatitis B and hepatitis C carrier status and perinatal outcomes[J].Liver Int,2011,31(8):1163-1170.
[10]CHEN J,ZHANG S,ZHOU YH,et al.Minimal adverse influence of maternal hepatitis B carrier status on perinatal outcomes and child’s growth[J].J Matern Fetal Neonatal Med,2015,28(18):2192-2196.
[11]CHANG CY,AZIZ N,POONGKUNRAN M,et al.Serum aminotransferase flares in pregnant and postpartum women with current or prior treatment for chronic hepatitis B[J].J Clin Gastroenterol,2018,52(3):255-261.
[12]ZHUANG X,CUI AM,WANG Q,et al.Liver dysfunction during pregnancy and its association of with preterm birth in China:A prospective cohort study[J].EBio Medicine,2017,26:152-156.
[13]CUNDY T,ACKERMANN E,RYAN EA.Gestational diabetes:New criteria may triple the prevalence but effect on outcomes is unclear[J].BMJ,2014,348:g1567.
[14]KONG D,LIU H,WEI S,et al.A meta-analysis of the association between gestational diabetes mellitus and chronic hepatitis B infection during pregnancy[J].BMC Res Notes,2014,7:139.
[15]LAO TT,TSE KY,CHAN LY,et al.HBsAg carrier status and the association between gestational diabetes with increased serum ferritin concentration in Chinese women[J].Diabetes Care,2003,26(11):3011-3016.
[16]TO WW,CHEUNG W,MOK KM.Hepatitis B surface antigen carrier status and its correlation to gestational hypertension[J].Aust N Z J Obstet Gynaecol,2003,43(2):119-122.
[17]TSE KY,HO LH,LAO T.The impact of maternal HBs Ag carrier status on pregnancy outcomes:A case-control study[J].J Hepatol,2005,43(5):771-775.
[18]LAO TT,CHAN BC,LEUNG WC,et al.Maternal hepatitis Binfection and gestational diabetes mellitus[J].J Hepatol,2007,47(1):46-50.
[19]LAO TT,CHUNG MK,CHEUNG TK,et al.Antenatal hepatitis B and increased risk of gestational diabetes mellitus-Implications for obstetric care[J].J Infect,2016,72(5):625-626.
[20]SAFIR A,LEVY A,SIKULER E,et al.Maternal hepatitis B virus or hepatitis C virus carrier status as an independent risk factor for adverse perinatal outcome[J].Liver Int,2010,30(5):765-770.
[21]REDDICK KL,JHAVERI R,GANDHI M,et al.Pregnancy outcomes associated with viral hepatitis[J].J Viral Hepat,2011,18(7):e394-e398.
[22]LAO TT,SAHOTA DS,CHENG YK,et al.Maternal hepatitis Bsurface antigen status and incidence of pre-eclampsia[J].JViral Hepat,2013,20(5):343-349.
[23]TAN J,MAO X,ZHANG G,et al.Hepatitis B surface antigen positivity during pregnancy and risk of gestational diabetes mellitus:A systematic review and meta-analysis[J].J Viral Hepat,2018,25(11):1372-1383.
[24]MAGHBOOLI Z,HOSSEIN-NEZHAD A,RAHMANI M,et al.Relationship between leptin concentration and insulin resistance[J].Honn Metab Res,2007,39(12):903-907.
[25]MURAKAMI S.Hepatitis B virus X protein:Structure,function and biology[J].Intervirology,1999,42(2-3):81-99.
[26]WINKLER G,CSEH K,BARANYI E,et al.Tumour necrosis factor system in insulin resistance in gestational diabetes[J].Diabetes Res Clin Pract,2002,56(2):93-99.
[27]BOZKAYA H,BOZDAYI M,TURKYILMAZ R,et al.Circulating IL-2,IL-10 and TNF-alpha in chronic hepatitis B:Their relations to HBe Ag status and the activity of liver disease[J].Hepatogastroenterology,2000,47(36):1675-1679.
[28]LEE JG,LEE S,KIM YJ,et al.Association of chronic viral hepatitis B with insulin resistance[J].World J Gastroenterol,2012,18(42):6120-6126.
[29]WANG J,LU W,LI J,et al.Hemodynamic effects of reninangiotensin-aldosterone inhibitor andβ-blocker combination therapy vs.β-blocker monotherapy for portal hypertension in cirrhosis:A meta-analysis[J].Exp Ther Med,2017,13(5):1977-1985.
[30]MA X,SUN D,LI C,et al.Chronic hepatitis B virus infection and preterm labor(birth)in pregnant women-an updated systematic review and meta-analysis[J].J Med Virol,2018,90(1):93-100.
[31]CHENG L,YANG XH,HU JN.Clinical features and management strategies of re-pregnant women with chronic hepatitis B virus infection after implementation of"two-child policy"[J].Chin JClin Infect Dis,2017,10(3):181-186.(in Chinese)程丽,杨小红,胡健女.“全面二孩”后合并慢性乙型肝炎病毒感染再妊娠妇女临床特点分析[J].中华临床感染病杂志,2017,10(3):181-186.
[32]XIN X,WANG Y,CHENG J,et al.Seroepidemiological survey of hepatitis B virus infection among 764,460 women of childbearing age in rural China:A cross-sectional study[J].JClin Virol,2016,81:47-52.