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Risk factors for gestational diabetes mellitus in pregnant women with chronic HBV infection and its influence on maternal and fetal outcomes
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摘要:
目的 探讨慢性HBV感染的孕妇出现妊娠期糖尿病(GDM)的相关因素、妊娠结局及其对所分娩新生儿的影响。 方法 回顾性纳入2017年1月—2017年12月于首都医科大学附属北京佑安医院就诊、分娩及产后随诊的317例慢性HBV感染的孕妇。根据是否合并GDM分为慢性HBV感染合并GDM组及慢性HBV感染对照组。记录入组孕妇的HBV血清学标志物、肝功能、HBV DNA定量、妊娠合并症、分娩方式及新生儿出生时情况。满足正态分布的计量资料的2组间比较采用t检验或t′检验，不满足正态分布的计量资料的2组间比较采用Mann-Whitney U检验；计数资料2组间比较采用χ2检验或Fisher精确法检验；采用二元logistic多因素回归分析慢性HBV感染的母亲出现GDM的危险因素。 结果 317例母亲中慢性HBV感染合并GDM共64例，占整体人数20.19%，对照组为253例，占整体人数79.81%。慢性HBV感染合GDM组的孕妇在年龄(Z=-2.652)、基线ALT(Z=-4.393)、基线AST(Z=-2.457)及HBV DNA定量方面高于对照组(P值均＜0.05)。logistic回归分析显示，HBV DNA定量[OR(95%CI)=23.40(7.10~77.14)，P＜0.001]及高龄[OR(95%CI)=1.10(1.02~1.17)，P=0.01]是慢性HBV感染孕妇发生GDM的独立危险因素。慢性HBV感染合并GDM的孕妇在分娩时更容易出现胎膜早破(χ2=4.514，P=0.034)；所分娩的新生儿更容易出现早产(χ2=9.293，P=0.002)及胎儿宫内窘迫(P=0.018)。 结论 HBV DNA定量及高龄是慢性HBV感染母亲发生GDM的危险因素。慢性HBV感染的孕妇合并GDM增加了胎膜早破、胎儿宫内窘迫及早产的发生率。 Abstract:Objective To investigate the factors for gestational diabetes mellitus (GDM) in pregnant women with chronic hepatitis B virus (HBV) infection, their pregnancy outcome, and related influence on neonates. Methods A retrospective analysis was performed for 317 pregnant women with chronic HBV infection who were treated, gave birth, and were followed up in Beijing YouAn Hospital, Capital Medical University, from January to December 2017, and according to the presence or absence of GDM, they were divided into chronic HBV+GDM group and chronic HBV control group. Related data were recorded, including HBV serology, liver function, HBV DNA quantification, pregnancy comorbidities, mode of delivery, and the condition of neonates at birth. The t-test or t′-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher's exact test was used for comparison of categorical data between two groups; a binary logistic regression analysis was used to investigate the risk factors for GDM in mothers with chronic HBV infection. Results Among the 317 mothers, 64 (20.19%) had chronic HBV infection and GDM, and there were 253 mothers (79.81%) in the control group. Compared with the control group, the chronic HBV+GDM group had significantly higher age (Z=-2.652, P < 0.05), baseline alanine aminotransferase (Z=-4.393, P < 0.05), baseline aspartate aminotransferase (Z=-2.457, P < 0.05), and HBV DNA quantification (P < 0.05). The logistic regression analysis showed that HBV DNA quantification (odds ratio [OR]=23.40, 95% confidence interval [CI]: 7.10-77.14, P < 0.001) and old age (OR=10.10, 95% CI: 1.02-1.17, P=0.01) were independent risk factors for GDM in pregnant women with chronic HBV infection. The pregnant women with chronic HBV infection and GDM were more likely to experience premature rupture of membranes during delivery (χ2=4.514, P=0.034), and the neonates born to these women were more likely to experience preterm birth (χ2=9.293, P=0.002) and fetal intrauterine distress (P=0.018). Conclusion HBV DNA quantification and old age are risk factors for GDM in mothers with chronic HBV infection, and GDM in pregnant women with chronic HBV infection may increase the incidence rate of premature rupture of membranes, fetal intrauterine distress, and premature delivery. -
Key words:
- Hepatitis B Virus /
- Diabetes, Gestational /
- Pregnant Women
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表 1 2组患者的临床特征比较
指标 HBV感染合并GDM组
(n=64)HBV感染对照组
(n=253)统计值 P值 年龄(岁) 30(27~33) 28(26~31) Z=-2.652 0.008 ALT(U/L) 18.15(14.63~31.75) 14.10(11.00~20.45) Z=-4.393 ＜0.001 AST(U/L) 21.80(17.75~33.90) 19.70(16.75~25.20) Z=-2.457 0.014 TBil(μmol/L) 7.55(6.10~9.48) 8.20(6.55~10.70) Z=-1.881 0.060 Alb(g/L) 36.30(34.55~37.28) 36.10(34.40~37.65) Z=-0.013 0.990 CHO(mmol/L) 5.75(5.00~6.40) 5.90(5.10~6.70) Z=-0.774 0.439 HBV DNA[例(%)] ＜0.001 ＜2 log10IU/mL 3(4.7) 131(51.8) 2~6 log10IU/mL 26(40.6) 5(2.0) ＞6 log10IU/mL 35(54.7) 117(46.2) HBeAg[例(%)] χ2=2.230 0.135 阴性 29(45.3) 141(55.7) 阳性 35(54.7) 112(44.3) 合并妊娠期高血压[例(%)] 1(1.6) 3(1.2) 0.814 合并妊娠肝内胆汁淤积症[例(%)] 3(4.7) 4(1.6) 0.169 
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表 2 慢性HBV感染孕妇于分娩前出现GDM的单因素及多因素分析
参数 单因素分析结果 多因素分析结果 OR(95%CI) P值 OR(95%CI) P值 年龄(岁) 1.08(1.01~1.15) 0.03 1.10(1.02~1.17) 0.01 ALT(U/L) 1.01(1.00~1.01) 0.05 AST(U/L) 1.01(1.00~1.02) 0.04 HBV DNA
(可被检测到)21.83(6.68~71.42) ＜0.001 23.40(7.10~77.14) ＜0.001
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表 3 慢性HBV感染母亲合并GDM对母亲分娩时的影响
母婴结局 HBV感染合并GDM组
(n=64)HBV感染对照组
(n=253)χ2值 P值 先兆流产[例(%)] 1(1.6) 3(1.2) 0.814 先兆早产[例(%)] 0 4(1.6) 0.178 胎膜早破[例(%)] 5(7.8) 6(2.4) 4.514 0.034 羊水浑浊[例(%)] 8(12.5) 42(16.6) 1.224 0.693 剖宫产[例(%)] 37(57.8) 112(44.3) 3.761 0.052
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表 4 慢性HBV感染母亲合并GDM对新生儿出生时的影响
新生儿结局 HBV感染合并GDM组
(n=64)HBV感染对照组
(n=253)χ2值 P值 性别[例(%)] 0.570 0.450 男 35(54.7) 125(49.4) 女 29(45.3) 128(50.6) 早产[例(%)] 8(12.5) 8(3.2) 9.293 0.002 胎儿窘迫[例(%)] 5(7.9) 0 0.018 新生儿窒息[例(%)] 0 3(1.2) 1.000 胎儿发育异常[例(%)] 8(12.5) 17(6.7) 3.012 0.234
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