非酒精性脂肪肝对乙型病毒性肝炎孕妇妊娠结局和抗病毒疗效影响的回顾性队列研究

doi:10.19871/j.cnki.xfcrbzz.2022.02.012

摘要/Abstract

摘要： 目的研究非酒精性脂肪肝（NAFLD）对乙型病毒性肝炎孕妇妊娠结局和孕期抗病毒治疗效果的影响,为完善该群体孕期和围生期管理提供更多可靠证据。方法选取2020年1月1日至2021年12月31日在南京市第二医院产检并分娩的乙型病毒性肝炎孕妇,根据有无NAFLD分为NAFLD组（35例）和non-NAFLD组（156例）,通过倾向性得分匹配进行配对,对不良妊娠结局（25对患者）、抗病毒治疗效果（12对患者）进行组间差异比较。结果与non-NAFLD组相比,NAFLD组发生母儿不良结局的风险增加（均P<0.05）,对比两组不良妊娠结局的评分发现差异有统计学意义（P=0.01）。妊娠期及产后42d NAFLD组的血小板计数均高于non-NAFLD组,平均血小板体积NAFLD组低于non-NAFLD组。对两组中高病毒载量乙型肝炎孕妇妊娠中期启动抗病毒治疗的效果进行对比,发现基线、抗病毒治疗4周及8周乙型肝炎病毒DNA的水平差异均无统计学意义。结论 NAFLD会增加乙型肝炎孕妇母儿不良结局发生风险,对高病毒载量乙肝孕妇妊娠中期抗病毒治疗效果无明显影响。血小板相关指标可能是合并NAFLD乙肝孕妇潜在的疾病预后预测指标。

关键词: 非酒精性脂肪肝, 乙型病毒性肝炎孕妇, 妊娠结局, 抗病毒治疗

Abstract: Objective To study the effects of non-alcoholic fatty liver disease (NAFLD) on pregnancy outcome and the antiviral treatment during pregnancy of women with hepatitis B, so as to provide more reliable evidence for improving the management of pregnancy and perinatal period in this population. Method Pregnant women with hepatitis B who delivered in the Second Hospital of Nanjing from January 1, 2020 to December 31, 2021 were selected and divided into NAFLD group(35 cases) and non-NAFLD group(156 cases) according to whether NAFLD was present or not. Matches were made by propensity score matching. The statistical analysis of pregnancy outcomes（25 pairs of patients） and antiviral treatment effect（12 pairs of patients） were performed between the two groups. Result Compared with non-NAFLD group, NAFLD group had an increased risk of adverse maternal and off spring outcomes (both P<0.05). And there was statistically significant difference in the scores of adverse maternal and offspring outcomes between the two groups (P=0.01). It was found that platelet count in NAFLD group was higher than non-NAFLD group at different stage of gestation and postpartum 42 days, while mean platelet volume was lower than control group. There were no statistically significant differences in HBV DNA levels at baseline, 4 and 8 weeks of antiviral therapy between the two groups of pregnant women with high viral load who initiated antiviral therapy in the second trimester of pregnancy. Conclusion NAFLD increased the risk of maternal and fetal adverse outcomes in pregnant women with hepatitis B, but had no significant effect on antiviral therapy initiating in the second trimester of pregnancy in women with high viral load. The platelet-related indicators may be potential prognostic predictors of pregnant women with hepatitis B combined NAFLD.

Key words: Non-alcoholic fatty liver disease, Pregnant women with hepatitis B, Pregnancy outcomes, Antiviral therapy

王晨旭, 李丽, 韩国荣, 袁德平, 叶夏珺. 非酒精性脂肪肝对乙型病毒性肝炎孕妇妊娠结局和抗病毒疗效影响的回顾性队列研究[J]. 新发传染病电子杂志, 2022, 7(2): 57-62.

Wang Chenxu, Li li, Han Guorong, Yuan Deping, Ye Xiajun. Effect of non-alcoholic fatty liver disease on pregnancy outcomes and antiviral therapy in pregnant women with hepatitis B: a retrospective cohort study[J]. Electronic Journal of Emerging Infectious Diseases, 2022, 7(2): 57-62.

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