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目的:评价HBV感染孕妇发生产后出血的风险,为临床应用提供证据。方法:采用计算机和手工检索主题词的方法,检索Pub Med、EMBASE、Wiley Online Library、Cochrane Library、Google Scholar、CNKI、CBM、维普、万方,检索时限从建库至2015年8月,查找有关HBV感染孕妇产后出血的相关研究,对纳入研究的文献进行质量评价,采用Rev Man 5.2软件进行Meta分析。结果:最终纳入文献21篇,包括4篇病例对照研究和17篇队列研究,纳入孕妇共19 549例。Meta分析结果显示,HBV感染孕妇产后出血的发生率为9.3%,而正常孕妇产后出血的发生率为2.8%,差异有统计学意义(RR=2.97,95%CI为2.25~3.92,P<0.01)。肝功能正常的HBV感染孕妇与正常孕妇产后出血发生率比较(8.1%vs.3.3%),差异有统计学意义(RR=2.56,95%CI为2.01~3.25,P<0.01)。肝功能异常的HBV感染孕妇产后出血发生率为22.3%,明显高于肝功正常的HBV感染孕妇8.1%,差异有统计学意义(RR=2.67,95%CI为2.17~3.28,P<0.01)。结论:HBV感染孕妇产后出血发生风险高于正常孕妇,而肝功能异常的HBV感染孕妇产后出血发生风险进一步增高。
Objective: To evaluate the risk of postpartum hemorrhage in pregnant women with HBV infection and provide evidence for clinical application. Methods: The methods of computer and manual retrieval of keywords were used to search PubMed, EMBASE, Wiley Online Library, Cochrane Library, Google Scholar, CNKI, CBM, VW, Wanfang. HBV infection in pregnant women postpartum hemorrhage related studies, the quality of the literature included in the study, the use of Rev Man 5.2 software Meta analysis. RESULTS: Twenty-one articles were finally included, including four case-control studies and 17 cohort studies, including 19 549 pregnant women. Meta-analysis showed that the incidence of postpartum hemorrhage in pregnant women with HBV infection was 9.3%, while the incidence of postpartum hemorrhage in normal pregnant women was 2.8% (RR = 2.97, 95% CI 2.25-3.92, P <0.01) ). The incidence of postpartum hemorrhage between HBV infected pregnant women with normal liver function and normal pregnant women (8.1% vs.3.3%) was statistically significant (RR = 2.56, 95% CI 2.01-3.25, P <0.01). The incidence of postpartum hemorrhage in HBV-infected pregnant women with abnormal liver function was 22.3%, which was significantly higher than 8.1% of HBV infected pregnant women with normal liver function (RR = 2.67, 95% CI 2.17-3.28, P <0.01) . Conclusion: The risk of postpartum hemorrhage in pregnant women with HBV infection is higher than that in normal pregnant women, but the risk of postpartum hemorrhage in HBV infected pregnant women with abnormal liver function is further increased.