妊娠期乙型肝炎病毒感染患者孕期药物干预策略对母婴预后及产后肝炎发作的影响

摘要/Abstract

摘要： 目的探讨妊娠期乙型肝炎病毒(HBV)感染患者孕期药物干预策略对母婴预后及产后肝炎发作的影响。方法回顾性分析2018年1月至2023年1月南通大学附属南通第三医院接诊的102例HBV携带孕妇,根据治疗干预时间分为观察组(n=56),对照组(n=46)。观察组入组后第2 d开始口服替诺福韦治疗。对照组自妊娠24周开始口服替诺福韦治疗。比较两组患者各时间点的血清丙氨酸氨基转移酶(ALT)水平、外周血HBV DNA水平、乙肝e抗原(HBeAg)转阴率。记录妊娠结局、新生儿HBV DNA阳性感染率及孕妇产后肝炎发作率。结果妊娠6周、妊娠12周、妊娠24周时点,观察组血清ALT、HBV DNA水平低于对照组(均P＜0.05)。产后6周,两组血清ALT、HBV DNA水平比较,差异无统计学意义(均P>0.05)。妊娠6周、妊娠12周、妊娠24周、妊娠36周、产后6周时点,观察组和对照组的HBeAg转阴率比较[0.00%、1.79%、5.36%、5.36%、0.00% vs. 0.00%、0.00%、0.00%、2.17%、0.00%],差异无统计学意义(均P>0.05)。两组早产、胎膜早破、产后出血、宫内窘迫及高胆红素血症比较,差异无统计学意义(均P>0.05)。观察组产后肝炎的发作率为33.93%,低于对照组(58.70%,P＜0.05);新生儿HBV DNA阳性感染率低于对照组(P＜0.05)。结论妊娠期尽早启动抗病毒治疗方案,有助于降低母体产前病毒载量,提高母婴传播的阻断效果,减少母体产后肝炎的发作。

关键词: 乙型肝炎病毒, 妊娠, 治疗时机, 母婴结局, 产后肝炎

Abstract: Objective To explore the effects of medication intervention strategies during pregnancy on the prognosis of maternal and infant and the occurrence of postpartum hepatitis in patients with hepatitis B viral infection during pregnancy. Methods A retrospective analysis was conducted on 102 pregnant women with hepatitis B viral (HBV) infection who were admitted to Nantong Third Affiliated Hospital of Nantong University from January 2018 to January 2023. Based on the duration of treatment intervention, the participants were categorized into an observation group consisting of 56 cases and a control group comprising 46 cases. On the second day after enrollment, the observation group began oral treatment with tenofovir. The control group started taking oral tenofovir treatment from 24 weeks of pregnancy. The serum level of alanine aminotransferase (ALT), peripheral blood HBV DNA load and the negative rate of hepatitis B e antigen (HBeAg) were compared between the two groups at each time point. The outcomes of pregnancy, neonatal HBV DNA positive infection rate, and postpartum hepatitis incidence rate in pregnant women were recorded. Results At 6 weeks, 12 weeks, and 24 weeks of pregnancy, the serum ALT and HBV DNA levels in the observation group were lower than those in the control group (all P<0.05). At 6 weeks postpartum, no statistically significant differences were observed in serum ALT and HBV DNA levels between the two groups (both P>0.05). At 6 weeks, 12 weeks, 24 weeks, 36 weeks of pregnancy, and 6 weeks postpartum, there was no statistically significant difference in the HBeAg seroconversion rates between the observation group and the control group [0.00%, 1.79%, 5.36%, 5.36%, 0.00% vs 0.00%, 0.00%, 0.00%, 2.17%, 0.00%] (all P>0.05). There was no statistically significant difference between the two groups in terms of preterm birth, premature rupture of membranes, postpartum hemorrhage, intrauterine distress, and hyperbilirubinemia (all P>0.05). The incidence of postpartum hepatitis in the observation group was 33.93%, which was lower than that in the control group (58.70%, P<0.05), and the positive infection rate of HBV DNA in newborns was lower than that in the control group (P<0.05). Conclusion Early initiation of antiviral therapy during pregnancy can help reduce maternal prenatal viral load, improve the blocking effect of mother to child transmission, and reduce the occurrence of postpartum hepatitis in mothers.

Key words: Hepatitis B virus, Pregnancy, Timing of treatment, Maternal and infant outcomes, Postpartum hepatitis

王杏珍, 刘开颜, 王晓燕. 妊娠期乙型肝炎病毒感染患者孕期药物干预策略对母婴预后及产后肝炎发作的影响[J]. 肝脏, 2025, 30(8): 1046-1050.

WANG Xing-zhen, LIU Kai-yan, WANG Xiao-yan. The impact of medication intervention strategies during pregnancy on the prognosis of maternal and infant and the occurrence of postpartum hepatitis in hepatitis B infected patients[J]. Chinese Hepatolgy, 2025, 30(8): 1046-1050.

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