慢性乙型肝炎病毒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  

Clinical characteristics and efficacy evaluation of antiviral therapy in pregnant women with chronic hepatitis B virus infection

作　　者：杜鹃 郑维平 冯银宏 Juan Du;Wei-Ping Zheng;Yin-Hong Feng(Yuyao Maternity and Child Care Hospital,Yuyao 315400,Zhejiang Province,China;Yuyao People’s Hospital,Yuyao 315400,Zhejiang Province,China)

机构地区：[1]浙江省余姚市妇幼保健院,浙江省余姚市315400 [2]浙江省余姚市人民医院,浙江省余姚市315400

出　　处：《世界华人消化杂志》2020年第16期813-818,共6页World Chinese Journal of Digestology

摘　　要：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, HBe Ag)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6-34wk,平均20.3wk±7.8wk;ALT平均值为224.95U/L±19.6U/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HBe Ag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, HBV DNA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6wk时、治疗12wk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�BACKGROUND During pregnancy,decreased maternal liver blood supply and increased load metabolism make woman susceptible to hepatitis attack.Severe cases often develop liver failure,leading to coagulation mechanism abnormality,bleeding and infection,fetal distress,premature delivery,stillbirth,etc.Therefore,high attention to the treatment and management of pregnant women with chronic hepatitis B virus(HBV) infection is the key to reducing the mother-to-child transmission of HBV,representing an important issue of concern for clinical medical personnel.Therefore,the early diagnosis and treatment of hepatitis attack during pre gnancy are particularly important.AIM To observe the clinical characteristics of HBV in pregnant women and evaluate the efficacy of antiviral therapy.METHODS A total of 180 pregnant women with chronic HBV infection who visited Yuyao Maternal and Child Health Center of Zhejiang Province from February 2017 to June 2019 were selected as study subjects.Liver function was tested every 4 to 12 wk during pregnancy,and HBV serum markers were checked to determine whether there was hepatitis attack during pregnancy.For those with a definite diagnosis,tibivudine was given orally at a dose of 600 mg once per day.The clinical characteristics,alanine aminotransferase(ALT),HBV serum markers,and HBV DNA changes in pregnant women with chronic HBV infection were recorded.ALT recovery rate,HBV DNA and hepatitis B e antigen(HBeAg)negative conversion rate,and HBe Ag seroconversion rate after antiviral treatment at different time points during pregnancy were also recorded.RESUL TS Of the 180 pregnant women with chronic HBV infection included in this study,48(26.67%) had hepatitis attacks during pregnancy.The average age was 32.3±2.4 years.The duration of hepatitis attacks ranged from 6 to 34 wk,with an average of 20.3±7.8 wk.The mean value of ALT was 224.95±19.6 U/L.Compared with pregnant women without hepatitis attack during pregnancy,ALT and HBV DNA changes were significant(P <0.05),and hepatitis B surface antig

关 键 词：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 

分 类 号：R714.255[医药卫生—妇产科学] R714.251[医药卫生—临床医学]