Clinical characteristics and efficacy evaluation of antiviral therapy in pregnant women with chronic hepatitis B virus infection
- Author:
- No author available
- Journal Title:
- World Chinese Journal of Digestology
- Issue:
- 16
- DOI:
- 10.11569/wcjd.v28.i16.813
- Key Word:
- 慢性乙型肝炎病毒感染;孕妇;妊娠期;肝炎发作;临床特点;抗病毒治疗
Abstract： 背景 妊娠期间母体肝脏血供减少,负荷代谢增加等容易使妊娠期肝炎发作,严重者将出现肝衰竭,导致凝血机制异常,引起大量出血和感染,胎儿宫内窘迫,早产,死胎等.因此,对慢性乙型肝炎病毒(hepatitis B virus,HBV)感染孕妇治疗和管理的高度重视是降低HBV母婴传播的关键所在,也是临床医护人员关注的重要问题,尤其关注妊娠期肝炎发作的早期诊断和治疗尤为重要.目的 观察慢性HBV感染孕妇妊娠期肝炎发作的临床特点及抗病毒治疗的疗效评价.方法 选择2017-02/2019-06在浙江省余姚市妇幼保健院就诊的慢性HBV感染孕妇180例为研究对象,在妊娠期每4-12 wk行肝功能,HBV血清标志物检查以判断是否有妊娠期肝炎发作.对于明确诊断者即可给予口服替比夫定600 mg,1次/d.观察慢性HBV感染孕妇妊娠期肝炎发作临床特点和丙氨酸转氨酶(alanine aminotransferase,ALT),HBV血清标志物和HBV DNA的变化,以及妊娠不同时间点抗病毒治疗后ALT复常率,HBV DNA和乙型肝炎核心抗原(hepatitis B e antigen, HBeAg)阴转率及-HBeAg血清学转换率.结果 本研究纳入180例慢性HBV感染孕妇,其中48例(26.67％)孕妇妊娠期肝炎发作.年龄26-36岁,平均32.3岁±2.4岁;肝炎发作时间6-34 wk,平均20.3wk±7.8 wk;ALT平均值为224.95 U/L±19.6 U/L.与妊娠期无肝炎发作孕妇比较,妊娠期肝炎发作孕妇ALT, HBV DNA变化显著(P＜0.05),乙型肝炎表面抗原和HBeAg定量均明显降低(P＜0.05).妊娠期肝炎发作孕妇随着治疗时间的延长ALT复常率,HBVDNA阴转率,HBeAg阴转率及HBeAg血清学转换率均有不同程度的升高,尤其在治疗36 wk时,孕妇ALT复常率为100.0％,HBV DNA阴转率为72.92％,HBeAg阴转率为41.67％,HBeAg血清学转换率为37.5％,均明显高于治疗6 wk时、治疗12 wk时和治疗24 wk的疗效,差异比较均有统计学意义(P＜0.05).结论 慢性HBV感染孕妇妊娠期肝炎发作多发生在妊娠中期,给予积极抗病毒治疗后在第36周时HBeAg血清学转换率高.
- [1]Bolin, Niu,Dina Halegoua-De, Marzio,Jonathan M, Fenkel,etc.Obstetricians' and gynecologists' knowledge, education, and practices regarding chronic hepatitis B in pregnancy.[J].2017,30(6).
- [2]D. Conte,A. Colucci,E. Minola,etc.Clinical course of pregnant women with chronic hepatitis C virus infection and risk of mother-to-child hepatitis C virus transmission[J].2001,33(4).
- [3]Michael L, Power,Jay, Schulkin.Obstetrician/Gynecologists' Knowledge, Attitudes, and Practices Regarding Weight Gain During Pregnancy.[J].2017,(Spec ).
- [4]Marion G, Peters.Management of Autoimmune Hepatitis in Pregnant Women.[J].2017,13(8).
- [5]Kai‐,Chi Chang,Mei‐,etc.Decreased neonatal hepatitis B virus (HBV) viremia by maternal tenofovir treatment predicts reduced chronic HBV infection in children born to highly viremic mothers[J].2019,50(3).
- [6]Edward R, Newton,Linda, May.Adaptation of Maternal-Fetal Physiology to Exercise in Pregnancy: The Basis of Guidelines for Physical Activity in Pregnancy.[J].2017,10(Spec ).
- [7]Sarah, Schillie,Claudia, Vellozzi,Arthur, Reingold,etc.Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices.[J].2018,67(1).
- [8]Kimberly Page,Lawrence Leeman,Steven Bishop,etc.Hepatitis C Cascade of Care Among Pregnant Women on Opioid Agonist Pharmacotherapy Attending a Comprehensive Prenatal Program[J].2017,21(9).
- [9]Jodie Dionne-Odom,Alan T.N. Tita,Neil S. Silverman.#38: Hepatitis B in pregnancy screening, treatment, and prevention of vertical transmission[J].2016,(1).
- [10]Ishag, Adam,Magdi M, Salih,Ahmed A, Mohmmed,etc.Pregnant women carrying female fetuses are at higher risk of placental malaria infection.[J].2017,12(7).
- [11]Ma Xiaosong,Sun Dehong,Li Chuansheng,etc.Chronic hepatitis B virus infection and preterm labor(birth) in pregnant women—an updated systematic review and meta‐analysis[J].2018,90(1).
- [12]Ariel, Jaffe,Robert S, Brown.A Review of Antiviral Use for the Treatment of Chronic Hepatitis B Virus Infection in Pregnant Women.[J].2017,13(3).
- [13]Lucien Honoré Etame, Sone,Roger Ahouga, Voufo,Henriette Thérèse, Dimodi,etc.Prevalence and Identification of Serum Markers Associated with Vertical Transmission of Hepatitis B in Pregnant Women in Yaounde, Cameroon.[J].2017,6(1).
- [14]Page, Charlotte M.,Hughes, Brenna L.,Rhee, Eleanor H. J.,etc.Hepatitis C in Pregnancy: Review of Current Knowledge and Updated Recommendations for Management[J].2017,72(6).