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摘要：
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摘要：目的 探讨乙型肝炎肝硬化及抗病毒治疗对妊娠的影响及妊娠结局的预测方法。方法 对2009年1
月至2016年12月在首都医科大学附属北京地坛医院诊治的47例妊娠合并乙型肝炎肝硬化患者的临床资
料进行回顾性分析，依据孕期是否进行抗病毒治疗分为A组（22例）和B组（25例），A组患者孕期
进行抗病毒治疗，B组患者孕期未进行抗病毒治疗。比较两组产妇和新生儿并发症的发生情况，并通
过孕早期Child-Pugh分级和两项肝纤维化评估指标（APRI评分和FIB-4指数）对妊娠结局进行预测。
结果 孕早期B组患者ALT、AST、APRI评分和FIB-4指数均显著高于A组患者，差异有统计学意义（P
均＜ 0.05）。A组和B组患者孕早期HBV DNA低于检测下限比率分别为86.4%、20.0%（χ 2 = 20.624，
P ＜ 0.001）。B组中因中度以上贫血、肝病加重及因不良事件住院的患者显著多于A组，A组和B
组患者平均住院天数分别为（9.3 ± 3.2）天、（15.7 ± 12.2）天，差异有统计学意义（t = 2.388，P =
0.021），两组其他围产期产科并发症和胎儿结局差异无统计学意义。Child-Pugh B级或FIB-4 ≥ 4的
16例患者中有8例出现妊娠不良结局，RR = 7.750。结论 乙型肝炎肝硬化患者在妊娠期间使用抗病毒
药物治疗可降低肝病进展的风险和贫血等并发症的发生；Child-Pugh B级或FIB-4 ≥ 4的患者在妊娠
期间发生肝功能失代偿或胎儿不良结局的风险增加。
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Abstract: Objective To investigate the effects of the hepatitis B related cirrhosis and antiviral therapy on
pregnancy and the predictive methods of pregnancy outcomes associated with liver cirrhosis. Methods The
clinical data of 47 pregnant patients with hepatitis B related cirrhosis in Beijing Ditan Hospital, Capital Medical
University from January 2009 to December 2016 were retrospectively analyzed. According to whether or not
receiving antiviral therapy during pregnancy, the patients were divided into two groups: group A (22 cases)
and group B (25 cases). Patients in group A received antiviral therapy and patients in group B did not receive
antiviral therapy, the maternal and neonatal complications between the two groups were compared. Pregnancy
outcomes were evaluated by Child-Pugh grading and two liver fibrosis assessments (APRI scores and FIB-
4 index) during early pregnancy. Results ALT, AST, APRI scores and FIB-4 index of patients in group B were
significantly higher than those in group A during the first trimester, the differences was statistically significant
(P ＜ 0.05). The rates of HBV DNA below the lower detection limit in group A and group B were 86.4% and
20.0%, respectively (χ 2 = 20.624, P ＜ 0.001). In group B, the number of hospitalized patients with moderate
or more anemia, aggravated liver disease and adverse events were significantly higher than those in group
A. The average days of hospitalization in group A and group B were (9.3 ± 3.2) days and (15.7 ± 12.2) days,
respectively, the differences was statistically significant (t = 2.388，P = 0.021). Other perinatal obstetric
complications and fetal outcomes had no statistically significant differences between the two groups. Out
of 16 patients with Child-Pugh grade B or FIB-4 ≥ 4, 8 cases had adverse pregnancy outcomes, RR = 7.750.
Conclusions Antiviral therapy in patients with hepatitis B related cirrhosis during pregnancy can reduce the risk of
liver disease progression and complications such as anemia. Patients with Child-Pugh grade B or FIB-4 ≥4 have a
higher risk of hepatic decompensation or fetal adverse outcome during pregnancy.
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