南方医科大学学报

南方医科大学学报 ›› 2025, Vol. 45 ›› Issue (5): 995-1002.doi: 10.12122/j.issn.1673-4254.2025.05.12

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慢性乙型肝炎病毒感染影响孕妇妊娠中晚期及产后健康相关生活质量：一项前瞻性队列研究

邓悦滢1(), 耿雅雯1, 彭婷婷2, 丘峻朝3, 何丽娟4, 谢丹2, 陈姿任2, 欧阳石1,2(), 阎升光1,5,6()   

  1. 1.华北理工大学公共卫生学院，河北 唐山 063210
    2.广州医科大学附属第五医院感染性疾病科，广东 广州 511495
    3.广州医科大学附属第五医院产科，广东 广州 511495
    4.开滦总医院妇产科，河北 唐山 063210
    5.河北省煤矿卫生与安全重点实验室，河北 唐山 063210
    6.河北省职业卫生与安全协同创新中心，河北 唐山 063210
  • 收稿日期:2025-01-15 出版日期:2025-05-20 发布日期:2025-05-23
  • 通讯作者: 欧阳石,阎升光 E-mail:1014564621@qq.com;ouyangshi@gzhmu.edu.cn;yansg@ncst.edu.cn
  • 作者简介:邓悦滢，在读硕士研究生，E-mail: 1014564621@qq.com
  • 基金资助:
    河北省卫健委项目 快速康复护理降低公共卫生事件期间住院患者焦虑作用研究(20211885┫中国科技部“一带一路”外国专家创新人才交流项目┣G2022030048L)

Chronic HBV infection affects health-related quality of life in pregnant women in the second and third trimesters and postpartum period: a prospective cohort study

Yueying DENG1(), Yawen GENG1, Tingting PENG2, Junchao QIU3, Lijuan HE4, Dan XIE2, Ziren CHEN2, Shi OUYANG1,2(), Shengguang YAN1,5,6()   

  1. 1.School of Public Health, North China University of Science and Technology, Tangshan 063210, China
    2.Department of Infectious Diseases
    3.Department of Obstetrics, Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou 511495, China
    4.Department of Obstetrics and Gynecology, Kailuan General Hospital, Tangshan 063210, China
    5.Hebei Key Laboratory of Occupational Health and Safety for Coal Industry, Tangshan 063210, China
    6.Hebei Coordinated Innovation Center of Occupational Health and Safety, Tangshan 063210, China
  • Received:2025-01-15 Online:2025-05-20 Published:2025-05-23
  • Contact: Shi OUYANG, Shengguang YAN E-mail:1014564621@qq.com;ouyangshi@gzhmu.edu.cn;yansg@ncst.edu.cn

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摘要：

目的 对比分析慢性乙型肝炎病毒（HBV）感染孕妇与健康对照在妊娠中晚期至产后阶段的健康相关生活质量（HRQoL）差异，系统评估HBV感染对孕妇HRQoL的影响。 方法 运用前瞻性队列设计，纳入2023年4月17日~2023年9月25日在广州医科大学附属第五医院产科门诊就诊、孕周为16~24周的孕妇，每入组1例符合条件的乙肝孕妇，同时期匹配年龄、孕期、胎次相同的健康孕妇1例。最后入组70例乙肝孕妇及70例健康孕妇，分别在孕16~24周、孕32周~分娩和产后5~13周3个时间点进行动态随访及HRQoL评估。两组在各时间点的HRQoL评分比较使用t检验，采用混合线性模型分析其变化趋势，单因素方差分析和多元线性回归模型识别HRQoL降低的预测因子。 结果 在3个随访节点上，乙肝孕妇的HRQoL总评分均低于健康孕妇，同时在孕32周~分娩时两组评估得分均处于最低值。具体表现在孕32周~分娩时，乙肝孕妇组在心理分量表总分（74.27±13.43 vs 80.21±12.9，P=0.009）显著低于健康孕妇组；在产后5~13周，乙肝孕妇组在心理分量表总分（76.52±16.19 vs 85.02±6.51，P<0.001）和生理分量表得分（77.17±14.71 vs 83.09±10.1，P=0.009）显著低于健康孕妇组；乙肝病毒感染是孕妇孕晚期及产后的HRQoL降低的独立风险因子，同时自费支付医药、配偶对此次怀孕的中立态度及孕前合并其他疾病也是产后HRQoL较低的独立风险因子（P<0.05）。 结论 随着孕期负荷的加重，孕妇在孕晚期的HRQoL会出现下降，而乙肝病毒感染负向影响妊娠中晚期及产后HRQoL的生理功能和情感职能维度。在管理妊娠期的乙肝母亲时，应充分重视其HRQoL，进行及时合理的关怀及干预，有效改善其HRQoL。

关键词: 慢性乙型肝炎, 孕妇, 生活质量

Abstract:

Objective To evaluate the impact of HBV infection on pre- and postpartum health-related quality of life (HRQoL) in pregnant women. Methods A prospective matched cohort consisting of 70 HBV-infected and 70 healthy pregnant women was recruited from the Fifth Affiliated Hospital of Guangzhou Medical University between April 17 and September 25, 2023. HRQoL of the participants was assessed at 16-24 weeks of gestation, between 32 weeks and delivery, and 5-13 weeks postpartum. Mixed linear models were used for evaluating temporal trends of HRQoL changes, and univariate ANOVA with multiple linear regression was used to identify the predictors of HRQoL. Results Compared with healthy pregnant women, HBV-infected pregnant women had consistently lower total HRQoL scores across all the 3 intervals, with the lowest scores observed between 32 weeks of gestation and delivery, during which these women had significantly reduced mental component scores (74.27±13.43 vs 80.21±12.9, P=0.009) and postpartum mental (76.52±16.19 vs 85.02±6.51, P<0.001) and physical component scale scores (77.17±14.71 vs 83.09±10.1, P=0.009). HBV infection was identified as an independent risk factor affecting HRQoL during late pregnancy and postpartum periods. Additional independent risk factors for postpartum HRQoL reduction included self-pay medical expenses, spouse's neutral attitude toward the current pregnancy, and preexisting comorbidities (all P<0.05). Conclusion HRQoL of pregnant women deteriorates progressively in late pregnancy, and HBV infection exacerbates reductions of physical function and role emotion in late pregnancy and after delivery, suggesting the importance of targeted interventions for financial burdens, partner support and comorbid conditions to improve HRQoL of pregnant women with HBV infection.

Key words: chronic hepatitis B, pregnant women, quality of life