Maternal hepatitis B virus infection and preterm delivery: a retrospective cohort study
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摘要:
目的 研究母体乙型肝炎病毒(HBV)感染与早产的关联。 方法 将2011年1月 — 2014年12月期间在安徽医科大学第一附属医院分娩的12 186对母亲 – 单胎配对资料纳入本次研究,回顾性分析母体孕期HBV感染与早产的关联。 结果 该队列人群包括对照11 550例(94.78 %),HBV感染乙肝e抗原阴性者[HBeAg(–)]362例(2.97 %)和HBeAg(+)者274例(2.25 %)。母体HBV感染组平均孕周低于对照组,其中HBeAg(+)组平均孕周最低。HBV感染HBeAg(–)组早产儿发生率为17.13 %,与对照组相比差异无统计学意义。HBV感染HBeAg(+)组早产儿发生率为24.09 %,显著高于对照组的14.66 %(调整RR = 1.75,95 % CI = 1.29~2.38)。进一步分析发现,HBV感染HBeAg(–)组早期早产发生率为4.14 %,显著高于对照组的2.60 %(调整RR = 1.93,95 % CI = 1.02~3.65);HBV感染HBeAg(+)组晚期早产发生率为19.35 %,显著高于对照组的11.97 %(调整RR = 1.74,95 % CI = 1.25~2.41),HBV感染HBeAg(+)组早期早产发生率为4.74 %,也显著高于对照组(调整RR = 2.04,95 % CI = 1.17~3.56)。 结论 HBV感染HBeAg(–)是早期早产危险因素,HBV感染HBeAg(+)不仅增加早期早产而且增加晚期早产发生风险。 Abstract:Objective To investigate the association between maternal hepatitis B virus (HBV) infection and the risk of preterm delivery in a birth cohort study. Methods We collected the data on 12 186 mother-singleton infant pairs registered at First Affiliated Hospital of Anhui Medical University between January 2011 and December 2014 for a retrospective cohort study on the association between maternal HBV infection and preterm delivery. The puerperae of the cohort were grouped into cases (serum HBV surface antigen positive [HBsAg+]) and controls (HBsAg negative [HBsAg–]) based on the results of enzyme-linked immunosorbent assay. Results Of all the puerpaerae studied, 94.78% were controls; 2.97% were the cases being HBV e antigen negative (HBeAg–) and 2.25% were cases being HBeAg positive (HBeAg+). The mean gestational age of the cases was lower than that of the controls and the mean gestational age was the lowest in the HBeAg+ cases. The incidence rate of preterm delivery was 17.13% in the HBeAg– cases and was not significantly differ from that of the controls; but in the HBeAg+ cases, the incidence rate was 24.09% and significantly higher than that (14.66%) in the controls, with an adjusted relative risk [adj RR] of 1.75 (95% confidence interval [95% CI]: 1.25 – 2.41). Compared to the controls, the HBeAg– cases had a significantly increased incidence of early preterm delivery (4.14% vs 2.60%, adj RR = 1.93 [95% CI: 1.02 – 3.65]); in comparison with the controls, the HBeAg+ cases had a significantly higher incidence of late preterm delivery (19.35% vs. 11.97%, adj RR = 1.74 [95% CI: 1.36 – 2.59]) and also a significantly higher incidence of early preterm delivery (4.74% vs. 2.69%, adj RR = 2.04 [95% CI: 1.17 – 3.56]). Conclusion Maternal HBV infection with negative serum HBeAg is associated with an increased risk of early preterm delivery; maternal HBV infection with positive serum HBeAg increases both the risk of early and late preterm delivery. -
表 1 研究人群流行病学特征
特征 对照(n = 11 550) HBV感染HBeAg(–)(n = 362) HBV感染HBeAg(+)(n = 274) χ2 值 P 值 例数 % 例数 % 例数 % 年龄(岁) < 25 1 789 15.49 54 14.92 40 14.60 3.688 0.450 25~34 8 454 73.19 268 74.03 193 70.44 ≥ 35 1 307 11.32 40 11.05 41 14.96 孕前BMI(kg/m2) < 18.5 1 975 17.10 54 14.92 57 20.80 5.636 0.228 18.5~24.9 8 541 73.95 268 74.03 191 69.71 ≥25 1 034 8.95 40 11.05 26 9.49 产次 1次 8 766 75.90 276 76.24 182 66.42 15.161 0.001 < 1次 2 784 24.10 86 23.76 92 33.58 妊娠高血压 是 397 3.44 11 3.04 9 3.28 1.213 0.545 否 11 153 96.56 351 96.96 265 96.72 妊娠期糖尿病 是 917 7.94 59 16.30 25 9.12 32.675 < 0.001 否 10 613 92.06 303 85.70 249 90.88 先兆子痫 是 689 5.97 20 5.52 13 4.74 0.823 0.663 否 10 861 94.03 342 94.48 261 95.26 早产 1 693 14.66 62 17.13 66 24.09 20.124 < 0.001 晚期早产 1 383 11.97 46 12.71 53 19.35 24.729 < 0.001 早期早产 310 2.69 16 4.42 13 4.74 表 2 不同组别对象孕周比较
孕周(wks + day) 对 照 HBV感染HBeAg(–) HBV感染HBeAg(+) χ2 值 P 值 例数 % 例数 % 例数 % < 28 10 0.09 1 0.28 0 0.00 25.478 0.001 28~31 + 6 300 2.60 15 4.14 13 4.74 32~36 + 6 1 383 11.97 46 12.71 53 19.35 37~39 + 6 6 112 52.92 180 49.72 123 44.89 ≥ 40 3 745 32.42 120 33.15 85 31.03 表 3 早产发生未调整和调整的相对危险度
早产情况 对照 HBV感染HBeAg(–) HBV感染HBeAg(+) RR 值 95 % CI β $S_{\bar x}$ χ2 值 P 值 RR 值 95 % CI β $S_{\bar x}$ χ2 值 P 值 早产 未调整 1.00 1.20 0.91~1.59 0.185 0.142 1.699 0.192 1.85 1.39~2.45 0.614 0.142 18.243 < 0.001 调整 1.00 1.21 0.89~1.64 0.193 0.155 1.535 0.215 1.75 1.29~2.38 0.559 0.157 12.677 < 0.001 晚期早产 未调整 1.00 1.05 0.76~1.44 0.044 0.164 0.073 0.787 1.81 1.33~2.46 0.593 0.157 14.364 < 0.001 调整 1.00 1.09 0.77~1.53 0.081 0.174 0.218 0.640 1.74 1.25~2.41 0.551 0.174 10.830 0.001 早期早产 未调整 1.00 1.78 1.06~2.98 0.576 0.263 4.789 0.029 2.08 1.17~3.68 0.731 0.292 6.279 0.012 调整 1.00 1.93 1.02~3.65 0.658 0.325 4.103 0.043 2.04 1.17~3.56 0.715 0.283 6.384 0.012 -
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