上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

乙型肝炎病毒阳性与妊娠期糖尿病的相关性研究

车荣华 1，刘敏 2，杨杰莲 2，瞿俊杰 1，应豪 1   

  1. 1.同济大学附属第一妇婴保健院产科，上海 201204；2.上海公共卫生临床中心，上海 201508
  • 出版日期:2016-11-28 发布日期:2016-11-29
  • 通讯作者: 应豪，电子信箱：stephenying2011@51mch.com。
  • 作者简介:车荣华（1973—），女，副主任医师，硕士；电子信箱：lkcrh70@126.com。

Analysis of the association of hepatitis B virus positive with gestational diabetes mellitus

CHE Rong-hua1, LIU Min2, YANG Jie-lian2, QU Jun-jie1, YING Hao1   

  1. 1. Department of Obstetrics, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai 201204, China; 2. Department of Obstetrics and Gynecology, Shanghai Public Health Clinical Center, Shanghai 201508, China
  • Online:2016-11-28 Published:2016-11-29

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摘要：

目的 ·探讨不同肝功能状态的乙型肝炎病毒（HBV）感染与妊娠期糖尿病（GDM）的关系。方法 ·对748例GDM孕妇的临床资料进行回顾性分析。根据孕妇HBV感染及孕中期的肝功能情况分为3组。A组（肝功能异常，慢性乙型病毒性肝炎）124例，B组（肝功能正常，慢性HBV携带或非活动HBsAg携带）264例，C组（非HBV感染）360例。比较3组的糖代谢、妊娠结局及新生儿情况。结果 · ①A组糖耐量试验（OGTT）各时段血糖值、糖化血红蛋白（HbA1c）显著高于B组和C组。②A组妊娠期高血压疾病（HDCP）、妊娠期肝内胆汁淤积症（ICP）的发生率及剖宫产率均显著高于B组和C组。③A组新生儿的出生体质量、Apgar评分和巨大儿发生率均显著低于B组和C组。结论 ·慢性乙型病毒性肝炎孕妇孕中期肝功能的异常可导致糖代谢异常偏离范围更加明显，加重GDM病情及妊娠、分娩时和新生儿并发症发生的风险。加强HBV阳性孕妇的管理，定期监测孕妇的肝功能及血糖，并维持其基本正常，有助于减少不良妊娠结局。

关键词: 乙型肝炎病毒, 妊娠期糖尿病, 肝功能异常, 孕妇

Abstract:

Objective · To investigate the relationship of hepatitis B virus (HBV) infection in different liver function status with gestational diabetes mellitus (GDM). Methods · Clinical data of 748 pregnant women with GDM were retrospectively analyzed. They were assigned to three groups according to HBV infection status and their liver function at second trimester, the A group (with abnormal liver function and chronic hepatitis B, n=124), the B group (with normal liver function and chronic HBV carriers or inactive HBsAg carriers, n=264), and the C group (without HBV infection, n=360). The glucose metabolism, pregnancy outcomes, and neonates were compared among three groups. Results · The A group had significantly higher blood glucose and HbA1c levels at all time points in OGTT than the B and C groups. The A group had markedly higher rates of HDCP, ICP, and cesarean delivery than the B and C groups. The A group had significantly lower body weight, Apgar score, and the rate of macrosomia than the B and C groups. Conclusion · Abnormal liver function in pregnant women with chronic hepatitis B at the second trimester can result in apparent abnormal glucose metabolism, increase the risk of pregnancy, childbirth, and neonatal complications, and deteriorate GDM. Enhancing the management of HBV-positive GDM pregnant women, regularly monitoring liver function and blood glucose, and maintaining normal liver function and blood glucose are helpful for reducing adverse pregnancy outcomes.

Key words: hepatitis B virus, gestational diabetes mellitus, abnormal liver function, pregnant woman