摘要目的 探讨"全面二孩"政策实施后慢性乙型肝炎病毒(HBV)感染再妊娠妇女临床特点,为提高母婴围产期保健水平提供参考.方法 对杭州市西溪医院"全面二孩"实施前(91例,对照组)和实施后(82例,研究组)合并慢性HBV感染再生育妇女的临床资料进行回顾性分析,采用t检验或χ2检验比较两组孕妇基本情况、妊娠合并症、产后并发症、分娩方式和围生儿并发症方面的差异.结果 研究组和对照组孕妇在高龄(年龄>35岁)(31.71%比16.48%,χ2=5.528),流产次数(3.2±0.3比1.3±0.4,t=5.723),距第1次分娩间隔[(57.8±21.4)个月比(40.4±16.6)个月,t=6.691)],本次辅助生殖率(14.63%比5.49%,χ2=4.066),肝功能异常比例(13.41%比4.40%,χ2=4.618),孕期抗病毒治疗比例(34.14%比19.78%,χ2=4.561)和HBV DNA载量≥105IU/mL比例(35.36%比20.88%,χ2=4.515)方面差异具有统计学意义(P值均<0.05);在妊娠期高血压(12.20%比3.30%)、妊娠期糖尿病(14.63%比5.49%)、前置胎盘(9.76%比2.20%)、胎盘植入(3.66%比0)、羊水过多(12.20%比3.30%)、胎儿窘迫(14.63%比5.49%)及早产(14.63%比5.49%)方面的发生率差异均有统计学意义(χ2=4.914、4.066、4.524、3.838、4.914、4.066和4.066,P值均<0.05);研究组剖宫产(50.00%)、产后出血(14.63%)及产后贫血(19.51%)发生率明显高于对照组(35.16%、4.40%和8.79%,χ2=3.892、5.387和4.149,P值均<0.05).研究组低出生体质量儿(14.63%)、新生儿窒息(19.51%)及新生儿HBV感染率(15.85%)的发生率亦高于对照组(5.49%、6.59%和6.59%,χ2=4.066、6.486和3.883,P值均<0.05).结论 "全面二孩"政策实施后合并慢性HBV感染再生育孕妇临床特征更复杂,妊娠风险更大,应根据相应特点及策略加强孕期保健.

abstractsObjective To investigate the clinical features and management strategies of re-pregnant women with chronic hepatitis B virus infection after implementation of "two-child policy".Methods A total of 173 women with chronic hepatitis B virus infection in a subsequent pregnancy were enrolled from Hangzhou Xixi Hospital, among whom 91 cases were before implementation of the policy (from January to August 2015, control group), and 82 cases were after policy implementation (from March to December 2016, study group).The clinical data including basic information, pregnancy complications, postpartum complications, delivery mode and perinatal complications were retrospectively analyzed,t test or χ2 test was used for comparison between the two groups.Results There were significant differences in proportion of age>35 years (31.71% vs.16.48%,χ2=5.528), frequency of abortion(3.2±0.3 vs.1.3±0.4,t=5.723), fertility interval with first pregancy[(57.8±21.4)months vs.(40.4±16.6)months,t=6.691],rate of assisted reproduction(14.63% vs.5.49%,χ2=4.066),proportion of abnormal liver function(13.41% vs.4.40%,χ2=4.618),antiviral treatment during pregnancy (34.14% vs.19.78%,χ2=4.561) and proportion of HBV DNA loads >105IU/mL(35.36% vs.20.88%,χ2=4.515)between study group and control group (all P<0.05).The incidences of gestational hypertension(12.20% vs.3.30%), gestational diabetes mellitus(14.63% vs.5.49%),placenta previa(9.76% vs.2.20%),placental implantation(3.66% vs.0), hydramnio (12.20% vs.3.30%), fetal distress (14.63% vs.5.49%) and preterm birth(14.63% vs.5.49%)were also statistically significant between two groups (χ2=4.914, 4.066, 4.524, 3.838, 4.914, 4.066 and 4.066,all P<0.05).The incidence of cesarean section again(50.00%), postpartum hemorrhage(14.63%)and postpartum anemia(19.51%) were significantly higher in the study group than that in the control group(35.16%,4.40% and 8.79%,χ2=3.892, 5.387 and 4.149,all P<0.05).Compared with the control group, the incidence of low birth weight(14.63% vs.5.49%), neonatal asphyxia(19.51% vs.6.59%)and neonatal HBV infection rate(15.85% vs.6.59%)were higher in the study group (χ2=4.066, 6.486 and 3.883,all P<0.05).Conclusions The clinical characteristics of re-pregnant women with chronic hepatitis B virus infection are more complex and suffer greater risk of pregnancy, so antenatal care should be further reinforced after the comprehensive implementation of "two-child policy".