The Effect Of Hepatitis B Virus Infection On Serum Iron Makers In Pregnant Women

Objective: Hepatitis B virus(HBV)is the smallest double-stranded DNA virus known to lead to humans infection.It is HBV infection that likely causes abnormal serum iron markers in chronic HBV infection,while the impact of HBV infection on serum iron marker in pregnant women is unclear.This study was to clarify the changes of serum iron,ferritin,transferrin and total iron binding capacity in pregnant women with HBV infection,so as to guide pregnant women appropriate iron supplementation in gestation period.Methods:1.This study collected 1946 pregnant women and 1598 females in total.According to the criteria,157 normal pregnant woman,188 pregnant women with hepatitis B virus infection,109 healthy females and134 females with hepatitis B virus infection were enrolled.2.Hepatitis B surface antigen(HBs Ag)was detected by ELISA;serum ALT was detected by lactate dehydrogenase method;serum AST was detected by malate dehydrogenase enzymatic;C-reactive protein was detected by chemiluminescence;serum iron and total iron bindingcapacity were measured by ferrous oxazine method;ferritin and transferrin were measured by turbidimetric method.3.HBsAg positive samples were further confirmed by real-time PCR.4.HBV DNA positive samples were amplified by nested PCR.The amplified products were visualized by 1.5% agarose electrophoresis.5.Nucleotide sequences of the PCR products were determined by GenScript(Nanjing)company.The genotypes were determined based on complete genomic sequence.6.SPSS 18.0 statistical software was used to analyze the data.Results:1.At the same stage of pregnancy,a higher level of serum iron was found in pregnant women with HBV infection than normal pregnant woman,but there was no significant difference(p>0.05).At the same stage of pregnancy,the serum ferritin level was higher in pregnant women with HBV infection [65.50(45.15,119.05)μg/L;53.60(27.70,93.00)μg/L;20.20(12.85,36.05)μg/L] than normal pregnant woman [52.60(18.10,101.30)μg/L;36.60(21.65,68.35)μg/L;8.70(3.20,22.30)μg/L](Z=-1.72,p=0.04;Z=-2.33,p=0.01;Z=-4.42,p<0.01),while the serum transferrin and total iron binding capacity concentrations were increased in normal pregnant woman,and the difference were statistically significant between the two group in the second [30.40(24.95,33.10)μmol/L vs 32.40(27.75,38.9)μmol/L,Z=-3.26,p<0.01;59.58(48.90,64.88)μmol/L vs 63.50(54.39,76.25)μmol/L,Z=-3.26,p<0.01] and third trimesters [42.30(36.60,47.95)μmol/L vs 45.50(40.20,50.35)μmol/L,Z=-2.25,p=0.01;82.91(71.73,93.99)μmol/L vs89.18(78.79,98.69)μmol/L,Z=-2.21,p=0.01).Serum iron and ferritin values were lower with progressing gestation.Serum transferrin and total iron binding capacity levels increased with the advancing stage of pregnancy.2.The subjects were categorised into two groups: ALT≤40U/L group,ALT>40U/L group.In pregnant women with HBV infection,the serum iron and ferritin level were higher in ALT>40U/L group than ALT≤40U/L group [18.10(11.90,23.80)μmol/L vs 14.00(8.75,17.88)μmol/L,Z=-2.06,p=0.02;40.80(24.35,78.10)μg/L vs 25.50(15.25,51.05)μg/L,Z=-2.22,p=0.01].3.The subjects were categorised into two groups: AST≤42U/L group,AST>42U/L group.In pregnant women with HBV infection,the serum ferritin level was higher in AST>42U/L group than AST≤42U/L group[40.80(26.10,88.60)μg/L vs 25.60(15.80,52.75)μg/L,Z=-2.15,p=0.02].4.The subjects were categorised into two groups: CRP≤5mg/l group,CRP>5mg/l group.Regardless of what the level of CRP,the serum ferritin level was higher in pregnant women with HBV infection than normal pregnant woman,and there were significant difference inCRP≤5mg/l group [18.85(12.03,30.80)μg/L vs 7.30(3.10,17.35)μg/L,Z=-2.06,p=0.02).5.The serum ferritin level in pregnant women with HBV infection was positively related to HBV DNA load(r=0.172,p=0.042).6.HBV genotype B was dominants in pregnant women with HBV infection.Compared with HBV genotype C patients,the ferritin values of HBV genotype B patients was higher [46.90(14.85,74.58)vs 22.80(16.20,33.65),Z=-1.66,p<0.05].Conclusions:1.Our data suggest that there are iron metabolism imbalance and iron overload in pregnant women with HBV infection.We should monitor serum iron markers to guide pregnant women appropriate iron supplementation in gestation period.2.The ferritin values in HBV genotype B patients was higher than genotype C infections.Our result suggests that HBV genotypes might contribute to iron metabolism imbalance in pregnant women.