慢性HBV感染孕妇分娩后肝炎发作特点的真实世界研究  

A real-world study on the features of postpartum hepatitis flares in pregnant women with chronic HBV infection

作　　者：曾湛 周明芳[2] 林妍洁 毕潇月 杨柳 邓雯 蒋婷婷 胡蕾苹 许梦娇 张璐 易为[2] 李明慧[1,3] Zeng Zhan;Zhou Mingfang;Lin Yanjie;Bi Xiaoyue;Yang Liu;Deng Wen;Jiang Tingting;Hu Leiping;Xu Mengjiao;Zhang Lu;Yi Wei;Li Minghui(Department of Hepatology Division 2,Peking University Ditan Teaching Hospital,Beijing 100015,China;Departmentof Obstetrics and Gynecology,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;Department of Hepatology Division 2,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)

机构地区：[1]北京大学地坛医院教学医院肝病二科,北京100015 [2]首都医科大学附属北京地坛医院妇产科,北京100015 [3]首都医科大学附属北京地坛医院肝病二科,北京100015

出　　处：《中华肝脏病杂志》2024年第2期113-118,共6页Chinese Journal of Hepatology

基　　金：国家重点研发计划(2022YFC2603500,2022YFC2603505);北京市医院管理中心临床医学发展专项经费资助(XMLX202127);北京市医院管理中心消化内科学科协同发展中心资助课题(XXZ0302);首都卫生发展专项公共卫生项目(首发2022-1-2172)。

摘　　要：目的分析乙型肝炎病毒(HBV)感染孕妇在分娩后肝炎发作的临床特点。方法回顾性研究纳入符合标准的患者后,通过医院信息系统和医院检验系统收集慢性HBV感染孕妇分娩时、分娩后6、24、36和48周时的肝功能和HBV病毒学检查,并收集抗病毒治疗的药物种类和停药时间。对所得数据进行统计学分析。结果共纳入符合入组标准的孕妇533例,所有患者年龄(29.5±3.7)岁,共有408例为了母婴阻断在怀孕期间服用抗病毒药物,分娩时服用药物患者和未服用药物患者分娩时的丙氨酸转氨酶(ALT,z=-1.981,P=0.048)、天冬氨酸转氨酶(AST,z=-3.956,P<0.001)、HBV载量(z=-15.292,P<0.001)和HBeAg(z=-4.77,P<0.001)差异均有统计学意义,分娩后所有患者的ALT、AST、总胆红素、直接胆红素、白蛋白都在6周内出现呈上升趋势;分娩后48周内共有231例发生肝炎,其中有173例是在产后6周内就首次出现了ALT的异常。结论慢性HBV感染孕妇分娩后6周或停药后6周为肝炎高发期。Objective To analyze the clinical features of postpartum hepatitis flares in pregnant women with hepatitis B virus(HBV)infection.Methods A retrospective study was conducted.Patients who met the enrollment criteria were included.Liver function and HBV virology tests were collected from pregnant women with chronic HBV infection at delivery,6,24,36,and 48 weeks after delivery through the hospital information and test system.Additionally,antiviral therapy types and drug withdrawal times were collected.Statistical analysis was performed on all the resulting data.Results A total of 533 pregnant women who met the inclusion criteria were included,with all patients aged(29.5±3.7)years old.A total of 408 cases received antiviral drugs during pregnancy to interrupt mother-to-child transmission.There was no significant difference in the levels of alanine aminotransferase(ALT,z=-1.981,P=0.048),aspartate aminotransferase(AST,z=-3.956,P<0.001),HBV load(z=-15.292,P<0.001),and HBeAg(z=-4.77,P<0.001)at delivery in patients who received medication and those who did not.All patients ALT,AST,total bilirubin,direct bilirubin,and albumin showed an upward trend within six weeks after delivery.A total of 231 cases developed hepatitis within 48 weeks after delivery.Among them,173 cases first showed ALT abnormalities within six weeks postpartum.Conclusion Hepatitis flare incidence peaked six weeks after delivery or six weeks after drug withdrawal in pregnant women with chronic HBV infection.

关 键 词：妊娠 肝炎 慢性乙型肝炎病毒感染 

分 类 号：R714.251[医药卫生—妇产科学]