妊娠期乙型肝炎病毒感染与肝内胆汁淤积症对早产的交互作用研究
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摘要
目的探讨妊娠期乙型肝炎病毒(HBV)感染及妊娠期肝内胆汁淤积症(ICP)与早产发生风险的关系及其对早产发生风险的交互作用。方法以2017年1月-2018年4月在甘肃省妇幼保健院围产医学中心建卡就诊并随访到分娩结局的单胎孕妇为研究对象,采用化学发光法测定孕妇外周血乙型肝炎表面病毒抗原(HBs Ag)及总胆汁酸水平。以多因素Logistics回归模型分析HBV感染及ICP对早产的发生风险,并用相乘与相加模型分析其交互作用。结果与正常孕妇相比,妊娠期感染HBV不增加早产的发生风险,妊娠期患有ICP使早产的发生风险增加了1. 78倍(OR=1. 78,95%CI:1. 47～2. 16),适度早产的发生风险增加1. 97倍(OR=1. 97,95%CI:1. 63～2. 39),自发性早产的发生风险增加了2. 13倍(OR=2. 13,95%CI:1. 73～2. 63)。妊娠期HBV感染合并ICP孕妇,其子代发生早产、适度早产及自发性早产的风险增加2倍以上(OR=2. 34,95%CI:1. 85～2. 96; OR=2. 45,95%CI:1. 93～3. 11; OR=2. 64,95%CI:2. 07～3. 38)。HBV感染与ICP对早产、适度早产及自发性早产存在相乘与相加的交互作用。结论妊娠期HBV感染合并ICP显著增加了早产的发生风险,怀孕后积极防治HBV感染与ICP可降低适度早产与自发性早产的发生。
引文
[1]Wang FS,Fan JG,Zhang Z,et al.The global burden of liver disease:the major impact of China[J].Hepatology,2014,60(6):2099-2108.
[2]Liu J,Zhang S,Liu M,et al.Maternal pre-pregnancy infection with hepatitis B virus and the risk of preterm birth:a populationbased cohort study[J].Lancet Glob Health,2017,5(6):e624-e632.
[3]Hu Y,Ding YL,Yu L.The impact of intrahepatic cholestasis of pregnancy with hepatitis B virus infection on perinatal outcomes[J].Ther Clin Risk Manag,2014,10:381-385.
[4]Schweitzer A,Horn J,Mikolajczyk RT,et al.Estimations of worldwide prevalence of chronic hepatitis B virus infection:a systematic review of data published between 1965 and 2013[J].Lancet,2015,386(10003):1546-1555.
[5]Ozkan S,Ceylan Y,Ozkan O V,et al.Review of a challenging clinical issue:Intrahepaticcholestasis of pregnancy[J].World Journal of Gastroenterology,2015,21(23):7134-7141.
[6]Geenes V,Chappell LC,Seed PT,et al.Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes:a prospective population-based case-control study[J].Hepatology,2014,59(4):1482-1491.
[7]Sirilert S,Traisrisilp K,Sirivatanapa P,et al.Pregnancy outcomes among chronic carriers of hepatitis B virus[J].Int J Gynaecol Obstet,2014,126(2):106-110.
[8]Shan D,Hu Y,Qiu P,et al.Intrahepatic Cholestasis of Pregnancy in Women With Twin Pregnancy[J].Twin Res Hum Genet,2016,19(6):697-707.
[9]Oztas E,Erkenekli K,Ozler S,et al.Can routine laboratory parameters predict adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy?[J].J Perinat Med,2015,43(6):667-674.
[10]丁霄雁,耿慧,段彼得.乙型肝炎病毒感染对孕妇妊娠期肝内胆汁淤积症的影响研究[J].中华医院感染学杂志,2015,25(2):433-435.
[11]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.
[12]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):1-8.
[13]Keramat A,Younesian M,Gholami Fesharaki M,et al.Inactive Hepatitis B Carrier and Pregnancy Outcomes:A Systematic Review and Meta-analysis[J].Iran J Public Health,2017,46(4):468-474.
[14]Carballo-Nunez E,Gonzalez-Rodriguez L,Gonzalez-Boubeta R,et al.Perinatal outcomes in patients with cholestasis of pregnancy[J].Ginecol Obstet Mex,2015,83(12):776-784.
[15]中华医学会妇产科学分会产科学组.妊娠期肝内胆汁淤积症诊疗指南(2015)[J].中华妇产科杂志,2015,31(7):481-485.
[16]Howson CP,Kinney MV,Mcdougall L,et al.Born too soon:preterm birth matters[J].Reprod Health,2013,10 Suppl 1:S1.
[17]Knol MJ,Vanderweele TJ.Recommendations for presenting analyses of effect modification and interaction[J].International Journal of Epidemiology,2012,41(2):514-520.
[2]Liu J,Zhang S,Liu M,et al.Maternal pre-pregnancy infection with hepatitis B virus and the risk of preterm birth:a populationbased cohort study[J].Lancet Glob Health,2017,5(6):e624-e632.
[3]Hu Y,Ding YL,Yu L.The impact of intrahepatic cholestasis of pregnancy with hepatitis B virus infection on perinatal outcomes[J].Ther Clin Risk Manag,2014,10:381-385.
[4]Schweitzer A,Horn J,Mikolajczyk RT,et al.Estimations of worldwide prevalence of chronic hepatitis B virus infection:a systematic review of data published between 1965 and 2013[J].Lancet,2015,386(10003):1546-1555.
[5]Ozkan S,Ceylan Y,Ozkan O V,et al.Review of a challenging clinical issue:Intrahepaticcholestasis of pregnancy[J].World Journal of Gastroenterology,2015,21(23):7134-7141.
[6]Geenes V,Chappell LC,Seed PT,et al.Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes:a prospective population-based case-control study[J].Hepatology,2014,59(4):1482-1491.
[7]Sirilert S,Traisrisilp K,Sirivatanapa P,et al.Pregnancy outcomes among chronic carriers of hepatitis B virus[J].Int J Gynaecol Obstet,2014,126(2):106-110.
[8]Shan D,Hu Y,Qiu P,et al.Intrahepatic Cholestasis of Pregnancy in Women With Twin Pregnancy[J].Twin Res Hum Genet,2016,19(6):697-707.
[9]Oztas E,Erkenekli K,Ozler S,et al.Can routine laboratory parameters predict adverse pregnancy outcomes in intrahepatic cholestasis of pregnancy?[J].J Perinat Med,2015,43(6):667-674.
[10]丁霄雁,耿慧,段彼得.乙型肝炎病毒感染对孕妇妊娠期肝内胆汁淤积症的影响研究[J].中华医院感染学杂志,2015,25(2):433-435.
[11]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.
[12]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):1-8.
[13]Keramat A,Younesian M,Gholami Fesharaki M,et al.Inactive Hepatitis B Carrier and Pregnancy Outcomes:A Systematic Review and Meta-analysis[J].Iran J Public Health,2017,46(4):468-474.
[14]Carballo-Nunez E,Gonzalez-Rodriguez L,Gonzalez-Boubeta R,et al.Perinatal outcomes in patients with cholestasis of pregnancy[J].Ginecol Obstet Mex,2015,83(12):776-784.
[15]中华医学会妇产科学分会产科学组.妊娠期肝内胆汁淤积症诊疗指南(2015)[J].中华妇产科杂志,2015,31(7):481-485.
[16]Howson CP,Kinney MV,Mcdougall L,et al.Born too soon:preterm birth matters[J].Reprod Health,2013,10 Suppl 1:S1.
[17]Knol MJ,Vanderweele TJ.Recommendations for presenting analyses of effect modification and interaction[J].International Journal of Epidemiology,2012,41(2):514-520.