HBV携带孕妇妊娠期及产后肝炎发作风险及NAs干预观察

肝脏 ›› 2023, Vol. 28 ›› Issue (5): 527-529.

HBV携带孕妇妊娠期及产后肝炎发作风险及NAs干预观察

李芬, 韦淑珍, 李良, 莫雨灵, 傅小凡, 雷任国, 郑子玉

530023 南宁市第四人民医院(广西艾滋病临床治疗中心)肝科(李芬,李良,莫雨灵,傅小凡,雷任国,郑子玉),妇产科(韦淑珍)

收稿日期:2022-09-05 出版日期:2023-05-31 发布日期:2023-08-29
基金资助:
广西壮族自治区卫生健康委员会自筹经费科研课题(Z20210586)

The risk of hepatitis attack and the clinical value of NAs intervention in pregnant women with HBV infection during pregnancy and postpartum

LI Fen¹, WEI Shu-zhen², LI Liang¹, MO Yu-ling¹, FU Xiao-fan¹, LEI Ren-guo¹, ZHENG Zi-yu¹

1. Department of Hepatology, Nanning Fourth People’s Hospital (Guangxi AIDS clinical treatment center), Nanning 530023, China;
2. Department of Obstetrics and Gynecology, Nanning Fourth People’s Hospital (Guangxi AIDS clinical treatment center), Nanning 530023, Guangxi

Received:2022-09-05 Online:2023-05-31 Published:2023-08-29

摘要/Abstract

摘要： 目的研究慢性乙型肝炎病毒(HBV)携带孕妇妊娠期及产后肝炎发作风险及核苷(酸)类似物(NAs)干预的价值。方法纳入2020年1月至2022年1月南宁市第四人民医院300例HBV携带孕妇,入院后依据患者治疗意愿分为观察组232例,对照组68例。于妊娠6周检查壳多糖酶3样蛋白1(CHI3L1),并于不同时点检测ALT、HBV DNA及HBeAg。对照组仅接受保肝治疗,观察组若肝炎发作或CHI3L1>79 ng/mL则长期口服替诺福韦,300 mg/d,1次/d;若无肝炎症状则自妊娠第24周开始口服替诺福韦,300 mg/d,1次/d,分娩后停药。比较两组患者各时点ALT水平、HBV DNA阴转率、HBeAg阴转率、肝炎发作率。结果观察组患者妊娠6周时HBV DNA阴转、HBeAg阴转为8例(3.45%)和0、妊娠12周时为61例(26.29%)和9例(3.88%)、妊娠24周时为102例(43.97%)和13例(5.60%)、妊娠36周时为163例(70.26%)和18例(7.76%),且妊娠36周时各项指标均优于其他时点(P<0.05);对照组患者各指标妊娠6周时为4.41%和0、妊娠12周时为8.82%和4.41%、妊娠24周时为11.76%和7.35%、妊娠36周时为13.24%和8.82%,差异无统计学意义(P>0.05)。观察组妊娠期及产后肝炎总发作率为21.55%(50/232),低于对照组的73.53%(50/68),差异有统计学意义(P<0.05)。结论无论有无NAs干预,HBV携带孕妇妊娠期及产后均有肝炎发作,且产后6周发作率较高,同时于妊娠期及产后行个体化NAs干预可有效降低肝炎总发作率。

关键词: 慢性乙型肝炎病毒, 孕妇, 妊娠期, 产后, 肝炎, 核苷(酸)类似物

Abstract: Objective To investigate the risk of hepatitis during pregnancy and postpartum in pregnant women carrying chronic hepatitis B virus (HBV) and the value of nucleoside analogues (NAs) intervention.Methods A total of 300 pregnant women with HBV admitted to our hospital from January 2020 to January 2022 were enrolled in the study. The patients were divided into observation group (232 cases) and control group (68 cases) according to their willingness to be treated.The chitosanase 3-like protein 1 (CHI3L1) were tested at 6 weeks of gestation, alanine aminotransferase (ALT), HBV DNA and hepatitis B e antigen (HBeAg) were also tested at different time points. The control group received only hepatoprotective therapy, while the observation group was given long-term NAs intervention if hepatitis attack or CHI3L1>79 ng/ml [oral tenofovir at 300 mg/d once/d if hepatitis flares or CHI3L1 > 79 ng/mL; or oral tenofovir at 300 mg/d once/d from the 24th week of gestation if no hepatitis symptoms were present and discontinued after delivery]. The ALT level, HBV DNA negative rate, HBeAg negative rate and hepatitis attack rate were compared between the 2 groups at each time point.Results With the extension of NAs intervention time, the HBV DNA negative rate and HBeAg negative rate in the observation group were significantly increased, and all the indicators at 36 weeks of pregnancy were better than other time points [6 weeks of pregnancy (3.45%, 0.00%), 12 weeks of pregnancy (26.29%, 3.88%), 24 weeks of pregnancy (43.97%, 5.60%), and 36 weeks of pregnancy (70.26%, 7.76%)]. There was no difference in the control group at 6 weeks of gestation (4.41%, 0.00%), 12 weeks of pregnancy (8.82%, 4.41%), 24 weeks of pregnancy (11.76%, 7.35%), and 36 weeks of pregnancy (13.24%, 8.82%) (P>0.05%). The total rate of hepatitis attacks during pregnancy and postpartum in the observation group (21.55%) was significantly lower than that in the control group (73.53%), P<0.05.Conclusion Regardless of NAs intervention, HBV carriers have hepatitis attacks during pregnancy and postpartum, and the attack rate is higher at 6 weeks after delivery, while individualized NAs intervention during pregnancy and postpartum is effective in reducing the total hepatitis attack rate.

Key words: Chronic hepatitis B virus, Pregnant women, Pregnancy, Postpartum, Hepatitis, Nucleoside analogues

李芬, 韦淑珍, 李良, 莫雨灵, 傅小凡, 雷任国, 郑子玉. HBV携带孕妇妊娠期及产后肝炎发作风险及NAs干预观察[J]. 肝脏, 2023, 28(5): 527-529.

LI Fen, WEI Shu-zhen, LI Liang, MO Yu-ling, FU Xiao-fan, LEI Ren-guo, ZHENG Zi-yu. The risk of hepatitis attack and the clinical value of NAs intervention in pregnant women with HBV infection during pregnancy and postpartum[J]. Chinese Hepatolgy, 2023, 28(5): 527-529.

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