The Korean Journal of Gastroenterology (대한소화기학회지)

The Korean Society of Gastroenterology (대한소화기학회)
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Clinical Characteristics and Gestational Complications Associated with Acute Hepatitis A in Pregnancy

임신부에서 발생한 급성 A형간염의 임상양상과 임신 합병증

  • Ryu, Ho-Seong (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Park, Seon-Young (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Lim, Sung-Ryoun (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kim, Hyung-Il (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Kee, Won-Ju (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Lee, Geum-Soo (Department of Internal Medicine, Christian Hospital) ;
  • Hong, Gun-Young (Department of Internal Medicine, Christian Hospital, Gwangju) ;
  • Cho, Sung-Bum (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Choi, Sung-Kyu (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Rew, Jong-Sun (Department of Internal Medicine, Chonnam National University Medical School)
  • 류호성 (전남대학교 의과대학 내과학교실) ;
  • 박선영 (전남대학교 의과대학 내과학교실) ;
  • 임성륜 (전남대학교 의과대학 내과학교실) ;
  • 김형일 (전남대학교 의과대학 내과학교실) ;
  • 기원주 (전남대학교 의과대학 내과학교실) ;
  • 이금수 (광주기독병원 내과) ;
  • 홍건영 (광주기독병원 내과) ;
  • 조성범 (전남대학교 의과대학 내과학교실) ;
  • 최성규 (전남대학교 의과대학 내과학교실) ;
  • 유종선 (전남대학교 의과대학 내과학교실)
  • Received : 2010.02.02
  • Accepted : 2010.07.09
  • Published : 2010.11.25
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Abstract

Background/Aims: Acute hepatitis A was recently significant increased among women with gestational age in Korea. However, the clinical course and gestational complications have not been fully elucidated in pregnant patients with acute hepatitis A. We evaluated the clinical impact of acute HAV infection in pregnancy. Methods: Twelve pregnant women out of 85 female patients with acute hepatitis A during 6 years were retrospectively reviewed. Results: The median age of the pregnant group was 26.5 years old. The number of patient with acute hepatitis A were 5 cases in the 1st trimester, 3 cases in the $2^{nd}$ and 4 cases in the $3^{rd}$. 4 cases had significant gestational complications. One case experienced the abortion in 1st trimester and one fetal distress was noted in $3^{rd}$ trimester. The latter case was delivered of a low birth weight infant (2,390 g) caused by premature rupture of membrane in 36 weeks of gestational age. Other two cases experienced premature contraction and they had been required tocolytic treatment. But, all mothers featured full recovery from HAV infection. Except one aborted fetus and one premature birth, Newborn babies were not affected by maternal hepatitis A. Conclusions: Acute HAV infection during pregnancy may be associated with the risk of gestational complications. HAV serology and vaccination for women with gestation age should be considered at high prevalence area of acute hepatitis A.

목적: 최근 국내 급성 A형간염의 발병 양상은 주로 20-30대에 현증 A형간염이 급격히 증가하고 있다. 서구의 보고에 의하면 임신 후반기에 급성 A형간염이 병발하면 임신 합병증 발생이 높아진다고 알려져 있다. 저자 등은 임신부에서 발생한 급성 A형간염의 임상 특징과 임신 합병증에 관하여 알아보고자 하였다. 대상 및 방법: 2004년 1월부터 2009년 7월까지 전남대학교병원 소화기내과와 광주기독병원에 입원한 급성 A형간염 여성 환자 85명 중 임신부 12명을 대상으로 병원 의무 기록과 전화 면담을 통해 자료를 수집하였다. 결과: 임신부 A형간염 환자 연령의 중앙값은 26.5세(22-31세)였고, 대상 환자 12명 중 9명에서 첫 번째 임신이었다. 임신 분기별 분포는 임신 1분기 5명, 임신 2분기 3명, 임신 3분기 4명이었다. 대상 환자의 입원 중 AST, ALT 최고치의 중앙값은 각각 213 U/L, 544 U/L를 보였고 ALP 193 U/L, 총 빌리루빈 6.08 mg/dL, PT 11.1초를 나타냈으며 환자들의 평균 재원일수는 9.2일이었다. 대상 환자의 33.3%(4/12)에서 임신 합병증을 경험하였으며 임신 1분기에 절박 유산 1명(8.3%), 임신 3분기에 조기 자궁 수축을 경험한 임신부 2명(16.7%)과 조산이 발생한 1명(8.3%)이 있었다. 유산을 한 임신부는 임신 6주에 발생하였고 조산을 한 임신부는 36주에 저체중 신생아(2,390 g)를 출산하였다. 조기 자궁 수축을 경험한 임신부는 자궁 수축 억제제를 투여받고 증상의 호전을 보여 정상 분만을 하였다. 모든 임신부는 급성 A형 간염의 악화 없이 회복하였고 유산된 1명의 태아와 1명의 조산아를 제외한 신생아들은 특별한 문제가 없었다. 결론: 임신 중 급성 A형간염이 병발하면 임신 합병증이 발생할 가능성이 있다. 따라서 가임기 여성의 급성 A형간염 항체 검사 및 예방 접종에 대한 사회적 관심이 필요하다. 향후 좀 더 많은 증례수의 분석을 위해 다기관 연구가 필요할 것이다.

Keywords

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