慢性HBV感染孕妇行母婴阻断治疗产后发作的影响因素分析

摘要/Abstract

摘要： 目的基于列线图分析慢性HBV感染孕妇产后发作的风险因素。方法样本为本院2021年1月—2023年1月收治的慢性HBV感染孕妇,共136例,所有患者均进行母婴阻断治疗。在抗病毒治疗前检测两组的血清丙氨酸氨基转移酶(ALT) 及乙型肝炎病毒相关指标。分娩后进行为期48周的随访,根据随访结果将其分为发作组(n=31)和未发作组(n=105)。logistic回归筛选产后乙型肝炎发作的风险因素,建立列线图模型,校准曲线评估模型拟合效果。结果发作组在治疗前的血清 ALT、 HBV DNA 定量、乙型肝炎表面抗原、e抗原、核心抗原水平分别为(29.30± 2.71)U/L、(7.42 ± 1.03)lgμg /mL、(4.25 ± 0.56)lgIU/mL、(2.57 ± 0.42)lgSCO、(7.49 ± 1.12)lgIU/mL,比未发作组高(P<0.05)。多因素分析结果表明ALT和病毒指标均是影响患者产后乙型肝炎发作的重要因素,且水平越高的孕妇发作风险越高(P<0.05)。校准曲线显示,平均绝对误差为0.026,表明此预测模型预测的校正曲线趋近于理想曲线。结论孕妇ALT水平和乙型肝炎相关病毒指标会影响其产后发作情况,可通过对这些指标的检测进行有效干预,降低发作风险。

关键词: 慢性HBV感染, 母婴阻断, 产后肝炎发作, 风险因素分析

Abstract: Objective This research seeks to identify the determinants of postpartum hepatitis outbreaks in pregnant women with hepatitis B infection who are receiving treatment to prevent mother-to-child transmission based on the nomogram model. Methods A total of 136 pregnant women with chronic hepatitis B infection treated from January 2021 to January 2023, were selected as research subjects. All patients received mother-to-child transmission blockade therapy. General data of the patients were collected, and serum levels of Alanine Aminotransferase (ALT), HBV DNA, Hepatitis B Surface Antigen (HBsAg), Hepatitis B e Antigen (HBeAg), and Hepatitis B Core-related Antigen (HBcrAg) were measured before antiviral therapy. Following delivery, all mothers were followed up for 48 weeks. Based on the follow-up outcomes, they were divided into a flare group (n=31) and a non-flare group (n=105). Logistic regression analysis was used to screen for factors affecting postpartum hepatitis flares, a nomogram model was developed, and its fit was evaluated using calibration curves. Results In the flare group, pre-treatment serum levels of ALT, HBcrAg, HBsAg, HBeAg, and HBV DNA were (29.30 ± 2.71) U/L, (7.42 ± 1.03) log₁₀μg/mL, (4.25 ± 0.56) log₁₀IU/mL, (2.57 ± 0.42) log₁₀SCO, and (7.49 ± 1.12) log₁₀IU/mL (P<0.05). Multivariate analysis indicated that levels of ALT, HBcrAg, HBsAg, HBeAg, and HBV DNA were significant factors affecting postpartum hepatitis flare, with higher levels associated with an increased risk of flare (P<0.05). The calibration curve showed a mean absolute error of 0.026, indicating that the predictive model’s calibration curve approached the ideal curve. Conclusion ALT levels and hepatitis B virus markers can influence postpartum flares in pregnant women. Effective interventions based on these markers can reduce the risk of flare.

Key words: Chronic hepatitis B infection, Mother-to-child transmission blockade, Postpartum hepatitis flare, Risk factor analysis

陈蓓蓓, 张晓沁. 慢性HBV感染孕妇行母婴阻断治疗产后发作的影响因素分析[J]. 肝脏, 2025, 30(5): 650-654.

CHEN Bei-bei, ZHANG Xiao-qin. Analysis of factors affecting postpartum flare in pregnant women with hepatitis B infection undergoing mother-to-child transmission blockade[J]. Chinese Hepatolgy, 2025, 30(5): 650-654.

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