年龄>30岁、ALT水平正常HBV感染孕妇的抗病毒治疗时机  

Timing of antiviral therapy for pregnant women with HBV infection and normal alanine aminotransferase level aged>30 years

作　　者：盛秋菊[1] 汪玉涵 丁洋[1] SHENG Qiuju;WANG Yuhan;DING Yang(Department of Infectious Diseases,Shengjing Hospital of China Medical University,Shenyang 110022,China)

机构地区：[1]中国医科大学附属盛京医院感染科,沈阳110022

出　　处：《临床肝胆病杂志》2024年第5期866-869,共4页Journal of Clinical Hepatology

基　　金：辽宁省科技厅应用基础研究计划(2022JH2/101500009)。

摘　　要：《慢性乙型肝炎防治指南(2022版)》扩大了慢性乙型肝炎患者抗病毒治疗适应证。ALT水平正常的慢性HBV感染者,HBV DNA阳性,年龄>30岁,指南建议开始抗病毒治疗。但对于年龄>30岁的孕妇,是否立即启动抗病毒治疗尚无统一观点。有观点认为,ALT水平正常的孕妇多为免疫耐受期,抗病毒治疗效果不佳,且孕期用药可能影响母婴安全。因此,即使孕妇年龄>30岁,也不主张在孕早期开始抗病毒治疗;也有观点认为,孕期机体的免疫改变可能是HBV免疫清除的特殊时期,若年龄>30岁,即使ALT水平正常,也应该立即抗病毒治疗,孕妇可能获得更好的病毒学甚至血清学应答。本文将针对上述问题,从孕期抗病毒治疗目的、治疗时机和停药时机等方面展开论述。Guidelines for the prevention and treatment of chronic hepatitis B(2022 edition)expanded the indications for antiviral therapy in patients with chronic hepatitis B.The guidelines recommend to initiate antiviral therapy for patients with chronic HBV infection who have a normal alanine aminotransferase(ALT)level,positive HBV DNA,and an age of>30 years.However,for pregnant women aged>30 years,no consensus has been reached on whether to start antiviral therapy immediately.Some experts believe that pregnant women with a normal ALT level are mostly in the immune-tolerant phase,and antiviral therapy tends to have an unsatisfactory therapeutic effect;in addition,medication during pregnancy may affect the safety of mothers and fetuses.Therefore,it is not recommended to start antiviral therapy immediately in early pregnancy even if the pregnant women are aged>30 years.Other experts believe that immune changes of the body during pregnancy may be a special period for HBV immune clearance,and if the patients are aged>30 years,antiviral therapy should be initiated immediately even if the patient has a normal ALT level;pregnant women may get better virologic and even serological response.With a focus on the above issues,this article elaborates on the purpose,treatment timing,and drug withdrawal timing of antiviral therapy during pregnancy.

关 键 词：乙型肝炎病毒 丙氨酸转氨酶 治疗学 母婴传播 

分 类 号：R714.251[医药卫生—妇产科学]