摘要
背景子痫前期严重危及母儿生命安全,国内外指南推荐具有高危因素的孕妇使用阿司匹林预防子痫前期发生,但对有子痫前期高危因素的慢性乙型肝炎病毒(hepatitis B virus,HBV)感染孕妇临床研究较少。目的探讨小剂量阿司匹林预防慢性HBV感染孕妇子痫前期的临床效果。方法选取2019年1月—2022年12月在解放军总医院第五医学中心妇产科早孕期建档、规律产检并完成分娩,且具有子痫前期高危因素的慢性HBV感染孕妇为研究对象。根据孕期是否使用阿司匹林分为用药组(孕12~16周每晚睡前服用阿司匹林,100 mg/d,至孕36周停药)和未用药组,比较两组孕妇在孕12周、孕20周、孕32周及分娩前的血压、肝功能、凝血功能及妊娠结局。结果共收集134例慢性HBV感染孕妇资料,用药组50例,平均年龄(34.38±3.95)岁;未用药组84例,平均年龄(34.59±4.58)岁,两组年龄差异无统计学意义(P>0.05)。用药组孕32周、分娩前收缩压和舒张压均低于未用药组(P<0.05),子痫前期发生率低于未用药组[2.00%(1/50)vs 14.29%(12/84),P=0.043]。两组肝功能各指标差异无统计学意义(P>0.05),凝血指标中只有凝血酶原时间用药组在分娩前高于未用药组[(11.18±0.76)s vs(10.71±0.65)s,P=0.018],差异有统计学意义。用药组分娩孕周大于未用药组[(38.76±1.22)周vs(35.64±1.63)周,P<0.001];新生儿窒息率[0 vs 8.3%,P=0.036]、早产率[4.00%vs 15.48%,P=0.042]均低于未用药组,差异均有统计学意义。结论在具有子痫前期高危的慢性HBV感染孕妇人群中,预防性使用小剂量阿司匹林可显著降低子痫前期发生率,改善凝血指标,降低妊娠不良结局的发生率。
Background Preeclampsia seriously endangers the safety of mother and child.Currently,domestic and foreign guidelines recommend that pregnant women with high-risk factors use aspirin to prevent the occurrence of preeclampsia.However,there are few clinical studies on pregnant women with chronic HBV infection,which is a high-risk factor for preeclampsia.Objective To explore the clinical outcomes of low-dose aspirin in preventing preeclampsia in pregnant women with chronic HBV infection.Methods Pregnant women with chronic HBV infection and high risk factors for preeclampsia who underwent regular prenatal examinations and successfully delivered at the Obstetrics and Gynecology Department of the Fifth Medical Center of Chinese PLA General Hospital from January 2019 to December 2022 were selected as the study objects.According to whether aspirin was used during pregnancy,pregnant women were divided into medication group(taking 100mg/d of aspirin before bedtime every night at 12-16 weeks of pregnancy and stopping at 36 weeks of pregnancy)and untreated group.The blood pressure,liver function,coagulation function,and pregnancy outcomes of the two groups of pregnant women were compared at 12,20 and 32 weeks of pregnancy,and before delivery.Results A total of 134 pregnant women with chronic HBV infection were collected,with 50 cases in the medication group having an average age of(34.38±3.95)years,and 84 cases in the untreated group,with an average age of(34.59±4.58)years.There was no statistically significant difference in age between the two groups(P>0.05).The systolic and diastolic blood pressure at 32 weeks of pregnancy and before delivery in the medication group were lower than those in the untreated group (P<0.05), and the incidence of preeclampsia was lower than that of the untreated group (2.00% [1/50] vs 14.29% [12/84], P=0.043). There was no statistically significant difference in liver function indicators between the two groups (P>0.05). Among coagulation indicators, only prothrombin time was significantly higher in the medication group during delivery than that in the untreated group ([11.18 ± 0.76] vs [10.71 ± 0.65], P=0.018). The gestational week of delivery in the medication group was longer than that in the untreated group ([38.76 ± 1.22] vs [35.64 ± 1.63], P< 0.001). The neonatal asphyxia rate (0% vs 8.3%, P=0.036) and premature birth rate (4.00% vs 15.48%, P=0.042) were lower in the medication group than those in the untreated group, and the differences were statistically significant. Conclusion In pregnant women with chronic HBV infection at high risk of preeclampsia, prophylactic use of low-dose aspirin can significantly reduce the occurrence of preeclampsia, improve coagulation indicators, and reduce the occurrence of adverse pregnancy outcomes.
作者
赵薇
白文佩
ZHAO Wei;BAI Wenpei(Department of Obstetrics and Gynecology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Department of Obstetrics and Gynecology,the Fifth Medical Center,Chinese PLA General Hospital,Beijing 100039,China)
出处
《解放军医学院学报》
CAS
2024年第5期475-480,共6页
Academic Journal of Chinese PLA Medical School
基金
北京市医院管理中心临床医学发展专项课题。
