乙型肝炎病毒感染对妊娠期肝内胆汁淤积症患者母婴免疫系统及妊娠结局的影响(1)
[摘要] 目的 探讨乙型肝炎病毒(HBV)感染对妊娠期肝内胆汁淤积症(ICP)孕妇母儿免疫系统及妊娠结局的影响。 方法 收集2009年3月～2015年1月吉林大学中日联谊医院收治的妊娠期肝内胆汁淤积症患者129例并将其作为对照组，收集同期吉林大学中日联谊医院收治的妊娠期肝内胆汁淤积症合并HBV感染患者71例并将其作为研究组。比较两组妊娠结局、新生儿情况及白细胞介素(IL)-18、IL-12、肿瘤坏死因子-α(TNF-α)水平。 结果 研究组产后出血率、早产率、剖宫产率与对照组比较明显较高，差异均有统计学意义(P < 0.05)。研究组新生儿体重、低体重儿百分率、Apgar评分与对照组比较差异无统计学意义(P > 0.05)。研究组IL-18、IL-12、TNF-α水平与对照组比较明显较高，差异均有统计学意义(P < 0.05)。 结论 ICP孕妇合并HBV感染患者较未合并HBV感染的患者免疫功能降低，更容易引发不良妊娠结局，发生早产、产后出血等各种并发症。ICP孕妇合并HBV感染患者体内IL-18、IL-12、TNF-α水平上升，应采取措施防止早产、产后出血等并发症的发生，以确保母婴健康。
[关键词] 肝内胆汁淤积症；乙型肝炎病毒；免疫系统；妊娠结局
[中图分类号] R575.6 [文献标识码] A [文章编号] 1673-7210(2015)07(c)-0059-04
[Abstract] Objective To investigate the impact of hepatitis B virus on pregnancy maternal immune system and pregnancy outcomes of pregnant women with intrahepatic cholestasis. Methods 129 cases with intrahepatic cholestasis of pregnancy were selected from March 2009 to January 2015 in Sino-Japanese Friendship Hospital of Jilin University and considered them as the control group， 71 cases with intrahepatic cholestasis of pregnancy and HBV-infected patients were collected on the same period in Sino-Japanese Friendship Hospital of Jilin University and considered them as the study group. The pregnancy outcomes， newborns， and IL-18， IL-12， TNF-α levels of two groups were compared. Results The rate of postpartum hemorrhage， preterm birth rate， cesarean section rate of the study group was significantly higher than the control group， the difference was statistically significant (P < 0.05). The birth weight， percentage of low birth weight children， Apgar scores of the study group compared with control group showed no significant difference (P > 0.05). IL-18， IL-12， TNF-α levels of the study group were significantly higher comparied with the control group， the differences were statistically significant (P < 0.05). Conclusion ICP HBV infection in pregnant women compared with patients without HBV-infected patients are more likely to lead to adverse pregnancy outcomes， premature delivery， increase the risk of postpartum hemorrhage and other complications. ICP pregnant patients with HBV infection in vivo IL-18， increased IL-12， TNF-α levels， should take measures to prevent the occurrence of preterm delivery， postpartum hemorrhage， and to ensure that maternal and child health.
[Key words] Intrahepatic cholestasis； Hepatitis B virus； The immune system； Pregnancy outcomes
妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy，ICP)是妊娠中晚期特有的一种常见肝脏疾病，以皮肤瘙痒和胆汁酸增高为主要临床特征，发病率为0.1%～15.6%[1]。ICP是高危妊娠之一，一般孕妇预后较好，但会对胎儿产生较大影响，容易导致胎儿宫内窘迫、早产、新生儿窒息，甚至引起死胎，使新生儿死亡率极大地增加[2]。ICP合并乙型肝炎病毒(hepatitis B virus，HBV)感染使母婴不良影响增加。笔者收集吉林大学中日联谊医院收治的71例ICP合并HBV感染患者，观察HBV感染对ICP患者母婴免疫系统及妊娠结局的影响，现报道如下： (高翔等)
[关键词] 肝内胆汁淤积症；乙型肝炎病毒；免疫系统；妊娠结局
[中图分类号] R575.6 [文献标识码] A [文章编号] 1673-7210(2015)07(c)-0059-04
[Abstract] Objective To investigate the impact of hepatitis B virus on pregnancy maternal immune system and pregnancy outcomes of pregnant women with intrahepatic cholestasis. Methods 129 cases with intrahepatic cholestasis of pregnancy were selected from March 2009 to January 2015 in Sino-Japanese Friendship Hospital of Jilin University and considered them as the control group， 71 cases with intrahepatic cholestasis of pregnancy and HBV-infected patients were collected on the same period in Sino-Japanese Friendship Hospital of Jilin University and considered them as the study group. The pregnancy outcomes， newborns， and IL-18， IL-12， TNF-α levels of two groups were compared. Results The rate of postpartum hemorrhage， preterm birth rate， cesarean section rate of the study group was significantly higher than the control group， the difference was statistically significant (P < 0.05). The birth weight， percentage of low birth weight children， Apgar scores of the study group compared with control group showed no significant difference (P > 0.05). IL-18， IL-12， TNF-α levels of the study group were significantly higher comparied with the control group， the differences were statistically significant (P < 0.05). Conclusion ICP HBV infection in pregnant women compared with patients without HBV-infected patients are more likely to lead to adverse pregnancy outcomes， premature delivery， increase the risk of postpartum hemorrhage and other complications. ICP pregnant patients with HBV infection in vivo IL-18， increased IL-12， TNF-α levels， should take measures to prevent the occurrence of preterm delivery， postpartum hemorrhage， and to ensure that maternal and child health.
[Key words] Intrahepatic cholestasis； Hepatitis B virus； The immune system； Pregnancy outcomes
妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy，ICP)是妊娠中晚期特有的一种常见肝脏疾病，以皮肤瘙痒和胆汁酸增高为主要临床特征，发病率为0.1%～15.6%[1]。ICP是高危妊娠之一，一般孕妇预后较好，但会对胎儿产生较大影响，容易导致胎儿宫内窘迫、早产、新生儿窒息，甚至引起死胎，使新生儿死亡率极大地增加[2]。ICP合并乙型肝炎病毒(hepatitis B virus，HBV)感染使母婴不良影响增加。笔者收集吉林大学中日联谊医院收治的71例ICP合并HBV感染患者，观察HBV感染对ICP患者母婴免疫系统及妊娠结局的影响，现报道如下： (高翔等)