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| 羊膜腔穿刺术对HBV携带孕妇胎儿宫内感染风险的研究 |
| Risk of intrauterine fetal infection in pregnant women with HBV by amniocentesis |
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| DOI：10.3969/j.issn.1007-8134.2019.04.019 |
| 中文关键词: HBV携带 羊膜腔穿刺术 宫内感染 产前诊断 |
| 英文关键词: HBV carrier amniocentesis intrauterine infection prenatal diagnosis |
| 基金项目:青岛市医药科研指导计划（2018-WJZD096）；青岛市医疗卫生优秀人才培养项目（YQR-2017069） |
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| 中文摘要: |
| 目的 探讨羊膜腔穿刺术对HBV携带孕妇胎儿宫内感染风险的影响，为产前诊断提供科学指导。方法 选取2015年1月—2019年1月就诊于青岛市妇女儿童医院的504例HBV携带孕妇作为研究对象，其中，将126例行羊膜腔穿刺术的孕妇设为观察组，其余未行羊膜腔穿刺术的378例孕妇设为对照组。对比分析不同HBeAg携带状态、HBV DNA载量、穿刺术中出血状况、操作者资质和经验下观察组与对照组胎儿宫内感染的发生情况。结果 504例HBV携带孕妇中胎儿宫内感染的总发生率为4.17%（21/504），其中，观察组感染率为7.14%（9/126），对照组感染率为3.17%（12/378）；在HBeAg（+）与HBV DNA＞1.0×107 cps/ml 2种情况下，观察组胎儿宫内感染发生率分别为15.38%（6/39）、70.00%（7/10），均显著高于对照组（P均＜0.05）；在HBeAg（-）与HBV DNA为l.0×103～1.0×107 cps/ml情况下，观察组和对照组胎儿宫内感染发生率差异均无统计学意义（P均＞0.05）。此外，穿刺出血情况、操作者资质和经验、分娩方式等对羊膜腔穿刺术后胎儿宫内感染发生率的影响差异均无统计学意义（P均＞0.05）。Logistic回归分析显示，HBeAg（+）、HBV DNA载量＞1.0×107 cps/ml、羊膜腔穿刺术是HBV携带孕妇胎儿宫内感染的危险因素。结论 HBeAg（+）、HBV DNA载量＞1.0×107 cps/ml、羊膜腔穿刺术是HBV携带孕妇胎儿宫内感染的危险因素。当HBV携带孕妇的HBeAg（+）、HBV DNA＞1.0×107 cps/ml时，羊膜腔穿刺术可能增加胎儿宫内感染的风险。HBV携带孕妇需要在产前诊断前对HBeAg状况和HBV DNA载量进行评估，以决定是否行羊膜腔穿刺术。 |
| 英文摘要: |
| Objective To explore the effect of amniocentesis on the risk of intrauterine fetal infection in pregnant women with HBV and provide scientific guidance for prenatal diagnosis. Methods A total of 504 pregnant women with HBV admitted in Qingdao Women and Children’s Hospital from January 2015 to January 2019 were included in the study. One hundred and twenty-six pregnant women who underwent amniocentesis were allocated in the observation group and the other 378 pregnant women without amniocentesis were taken as the control group. At different expression levels of HBeAg, load of HBV DNA, bleeding amount during puncture, qualifications and experience of operators, the intrauterine fetal infection rates between 2 groups were compared. Results The total incidence of intrauterine fetal infection in 504 pregnant women with HBV was 4.17% (21/504), that in observation group was 7.14% (9/126) and that in the control group was 3.17% (12/378). When HBeAg(+) and HBV DNA＞1.0×107 cps/ml co-existed, the incidence of intrauterine fetal infection in the observation group was 15.38% (6/39) and 70.00% (7/10) respectively, which were significantly higher than that in the control group (P＜0.0.5). When HBeAg(-) and HBV DNA between l.0×103 cps/ml and 1.0×107 cps/ml co-existed, the incidence of intrauterine fetal infection between 2 groups showed no significant difference (P＞0.05). In addition, the incidence of fetal intrauterine infection after amniocentesis had no significant difference among puncture bleeding, doctors’s experience and delivery mode (P＞0.05). Logistic regression analysis showed that HBeAg(+), HBV DNA load＞1.0×107 cps/ml and amniocentesis were risk factors for intrauterine infection in pregnant women with HBV. Conclusions HBeAg, HBV DNA load＞1.0×107 cps/ml and amniocentesis are risk factors for intrauterine infection in pregnant women with HBV. When HBeAg(+) and HBV DNA＞1.0×107 cps/ml co-exist in pregnant women with HBV, amniocentesis may increase the risk of intrauterine fetal infection. HBeAg status and HBV DNA load in pregnant women with HBV should be evaluated before prenatal diagnosis to determine whether amniocentesis is performed. |
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