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摘要：
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摘要：目的 探讨妊娠期肝内胆汁淤积症（intrahepatic cholestasis of pregnancy，ICP）合
并乙型肝炎病毒（hepatitis B virus，HBV）感染孕妇的血液指标及围产结局。方法 回
顾性收集2008年1月1日至2020年12月31日于首都医科大学附属北京地坛医院妇产科分
娩孕妇的临床资料，按照孕期是否存在ICP分为ICP组（491例）和非ICP组（504例），
根据HBV感染情况，将ICP组分为ICP合并HBsAg阳性组 [记为A组，401例，其中
HBV DNA阳性208例（A1组），HBV DNA阴性193例（A2组）] 和单纯ICP组（记为
B组，80例）；将非ICP组分为单纯HBV感染组（记为C组，200例）和无ICP无HBV
感染组（记为D组，304例）。比较各组母婴不良结局，包括胎死宫内、胎儿窘迫、
新生儿窒息、早产、低出生体重儿、产后出血、低婴儿重量指数（ponderal-index，
PI），比较合并HBV感染的ICP孕妇在发病时总胆汁酸（total bile acids，TBA）、丙
氨酸氨基转移酶（alanine aminotransferase，ALT）、天门冬氨酸氨基转移酶（aspartate
aminotransferase，AST）、总胆红素（total bilirubin，TBil）水平、重度ICP比例及
发病孕周与无肝炎ICP孕妇的差异。结果 各组患者年龄及产次无统计学差异（P均＞
0.05）。孕期ICP发病时，同时合并HBV感染孕妇（A1组与A2组）中重度ICP患者比
例、TBA、ALT、AST水平均显著高于单纯ICP患者（B组），发病孕周也显著提前，
其中HBV DNA阳性孕妇（A1组）中重度ICP患者比例，TBA、ALT、AST水平显著高于
HBV DNA阴性孕妇（A2组），发病孕周也显著提前（P ＜ 0.05），而组间TBil差异无
统计学意义（P ＞ 0.05）。ICP孕妇发生胎死宫内 [1.19%（6/491） vs 0]、早产 [23.63%
（116/491）vs 10.12%（51/504）]、产后出血 [11.8%（58/491）vs 3.2%（16/504）] 的
不良妊娠结局比例均显著高于无ICP组，且分娩孕周偏早 [（37.52 ± 1.955）周vs（39.09 ±
1.341）周]，剖宫产比例更高 [67.82%（333/491）vs 34.92%（176/504）]。合并HBV感
染的ICP孕妇，不良妊娠结局比例较单纯ICP孕妇升高，组间差异均有统计学意义（P均＜
0.05）。与其他组相比，A组孕妇的新生儿胎儿窘迫、新生儿窒息、新生儿低体质量发
生率偏高，新生儿平均体质量偏低，PI明显偏小（P均＜ 0.05）。结论 ICP对母儿均有
不良影响，合并HBV感染可加重ICP的不良影响，增加新生儿不良预后。
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Abstract: Objective To investigate the blood parameters and perinatal outcomes of
intrahepatic cholestasis of pregnancy (ICP) patients with hepatitis B virus (HBV) infection.
Methods Clinical data of pregnant women who delivered at the Department of Obstetrics and
Gynaecology, Beijing Ditan Hospital, Capital Medical University from January 1st, 2008 to
December 31st, 2020 were retrospectively collected. According to the presence or absence
of ICP during pregnancy, they were divided into ICP group (491 cases) and non ICP group
(504 cases). According to the HBV infection status, patients in ICP group were divided into
ICP combined with HBsAg positive group [marked as group A, 401 cases, among which 208
cases were with HBV DNA positive (group A1) and 193 cases were with HBV DNA negative
(group A2)] and simple ICP group (marked as group B); patients in non ICP group were divided
into simple HBV infection group (marked as group C, 200 cases) and non-ICP-non-HBV
infection group (marked as group D, 304 cases). Maternal and fetal adverse outcomes including
intrauterine fetal death, fetal distress, neonatal asphyxia, preterm delivery, low birth weight
infants, postpartum haemorrhage, low infant weight index (PI) were compared. Total bile acid
(TBA), alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TB) levels
at onset, proportion of severe ICP and gestational age at onset were compared between patients
in group A and group D. Results There were no significant differences in age and parity among
the groups (all P ＞ 0.05). At the onset of ICP during pregnancy, the proportion of moderate and
severe ICP, TBA, ALT and AST levels in pregnant women with HBV infection (group A1 and
A2) were significantly higher than those of simple ICP group (group B), the onset gestational age
was also significantly earlier. the proportion of moderate and severe ICP, TBA, ALT and AST
levels in group A1 were significantly higher than those of group A2, the onset gestational age
was also significantly earlier (all P ＜ 0.05), there was no significant difference in TBil between
the groups (P ＞ 0.05). The proportion of adverse pregnancy outcomes of ICP pregnant women
with intrauterine fetal death [1.19% (6/491) vs 0], premature birth [23.63% (116/491) vs 10.12%
(51/504)] and postpartum hemorrhage [11.8% (58/491) vs 3.2% (16/504)] were significantly
higher than that of the non-ICP group, the delivery gestational week [(37.52 ± 1.955) weeks vs
(39.09 ± 1.341) weeks] was earlier and the proportion of cesarean section [67.82% (333/491)
vs 34.92% (176/504)] was higher, the differences were statistically significant (all P ＜ 0.05).
The proportion of adverse pregnancy outcomes in ICP pregnant women with HBV infection
were higher compared with pregnant women with ICP alone, the differences were statistically
significant (all P ＜ 0.05). Compared with other groups, patients in group A had higher incidence
of fetal distress, neonatal asphyxia, low body mass, and significantly lower PI (all P ＜ 0.05).
Conclusions ICP has adverse effects on both mother and child, and combined HBV infection
can aggravate the adverse effects of ICP and increase the adverse prognosis of newborns.
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