本文選題：妊娠 + 肝炎��； 參考：《南昌大學(xué)》2017年碩士論文

【摘要】：目的:分析妊娠合并肝炎的病因、診斷、治療及預(yù)后。方法:對39例肝炎孕婦的臨床資料按早中期妊娠與晚期妊娠分2組,比較其重型肝炎的發(fā)生率、病死率、肝功能各項(xiàng)指標(biāo)及轉(zhuǎn)歸,比較39例中32例妊娠合并乙型病毒性肝炎的病人使用替比夫定抗病毒各指標(biāo)改善情況以及患者不同HBV-DNA的血清表型。按HBV-DNA載量水平,比較替比夫定抗病毒組與非抗病毒組的存活率,根據(jù)并發(fā)癥情況分析孕產(chǎn)婦及胎兒的預(yù)后。對其中非重型肝炎與重型肝炎分組,比較其并發(fā)癥的有無差異性,比較黃疸病人藥物干預(yù)前后瘙癢評分的差異性。結(jié)果:HBV感染是妊娠合并肝炎的主要原因,妊娠早中期與妊娠晚期比較,晚期發(fā)生重型肝炎發(fā)病率及病死率高,黃疸最高時ALT、AST、TBIL、DBIL、PT在妊娠早中期與妊娠晚期差異有統(tǒng)計(jì)學(xué)意義(P0.05),患者血清表型在HBV-DNA高病毒載量情況下,以1,3,5為優(yōu)勢表型,低病毒載量情況下,1、4、5為優(yōu)勢表型。在HBV-DNA高病毒載量情況下抗病毒組與非抗病毒組比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。肝腎綜合征、上消化道出血、彌漫性血管內(nèi)凝血、自發(fā)性腹膜炎、失血性休克、肝性腦病及死胎的發(fā)生率在重型肝炎中與非重型肝炎比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。在干預(yù)前后非重型肝炎瘙癢評分差異有統(tǒng)計(jì)學(xué)意義(P0.05),干預(yù)前后重型肝炎差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:晚期妊娠合并肝炎病情重,合并多種并發(fā)癥,預(yù)后差。在臨床實(shí)踐中,應(yīng)對臨床和生化指標(biāo)嚴(yán)密的動態(tài)觀察。同時,積極綜合治療和及時終止妊娠是改善預(yù)后的關(guān)鍵。
[Abstract]:Objective: to analyze the etiology, diagnosis, treatment and prognosis of pregnancy complicated with hepatitis. Methods: the clinical data of 39 pregnant women with hepatitis were divided into two groups according to early and middle pregnancy and third trimester pregnancy. The incidence, mortality, liver function and prognosis of severe hepatitis were compared. The improvement of tibivudine antiviral index and the serum phenotype of different HBV-DNA were compared in 32 of 39 pregnant women with viral hepatitis B. The survival rate of tibivudine antiviral group was compared with that of non-antiviral group according to HBV-DNA load. The prognosis of pregnant women and fetus was analyzed according to the complications. Among them, non-severe hepatitis and severe hepatitis were divided into two groups to compare the difference of complications and the score of pruritus in jaundice patients before and after drug intervention. Results the infection of HBV was the main cause of hepatitis in pregnancy. The incidence and mortality of severe hepatitis in the late stage were higher than that in the second trimester of pregnancy. There was significant difference in serum phenotype between early and third trimester of pregnancy (P 0.05) when the highest level of jaundice was found. The dominant phenotypes of serum phenotypes of patients with high HBV-DNA load were 1C 3N 5, and those with low viral load were 1 TBILD 5 as dominant phenotypic. The results showed that the serum phenotype of the patients with high HBV-DNA load was higher than that of the control group (P < 0.05). Under the condition of high viral load of HBV-DNA, the difference between antiviral group and non-antiviral group was statistically significant (P 0.05). The incidence of hepatorenal syndrome, upper gastrointestinal hemorrhage, diffuse intravascular coagulation, spontaneous peritonitis, hemorrhagic shock, hepatic encephalopathy and stillbirth in patients with severe hepatitis was significantly higher than that in non-severe hepatitis patients (P 0.05). There was significant difference in pruritus score of non-severe hepatitis before and after intervention (P 0.05), but there was no significant difference in severe hepatitis before and after intervention (P 0.05). Conclusion: the prognosis of late pregnancy with hepatitis is poor. In clinical practice, strict dynamic observation of clinical and biochemical indexes should be carried out. At the same time, active comprehensive treatment and timely termination of pregnancy is the key to improve prognosis.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.251

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本文編號：1992722