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标题: 肝爆发孕妇患有慢性乙型肝炎的临床和病毒学预测 [打印本页]

作者: StephenW 时间: 2015-10-9 22:52 标题: 肝爆发孕妇患有慢性乙型肝炎的临床和病毒学预测

Gut 2015;64:1810-1815 doi:10.1136/gutjnl-2014-308211

Hepatology

Original article

Clinical and virological predictors of hepatic flares in pregnant women with chronic hepatitis B

+ Author Affiliations

1Department of Infectious Diseases, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
2Department of Infectious Diseases, the Royal Women's Hospital, Melbourne, Victoria, Australia
3Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
4Department of Medicine, St. Vincents Hospital, University of Melbourne, Melbourne, Victoria, Australia
5Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia
6Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
7Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia

Correspondence to Dr Michelle Giles, Infectious Diseases Unit, Alfred Hospital, Level 2 Burnet Institute, 85 Commercial Road, Melbourne, VIC 3004, Australia; [email protected]

Received 5 August 2014
Revised 13 October 2014
Accepted 31 October 2014
Published Online First 27 November 2014

Abstract

Background Unique immunological changes occur during pregnancy; the impact of which, on virological and biochemical markers of hepatitis B infection is not well established. Rapid changes in the immunological profile post partum and consequent rebound of the inflammatory response may result in hepatic flares.

Methods Women with chronic hepatitis B were recruited during pregnancy into this observational study. Demographic and clinical data were collected together with virological and biochemical parameters at two time points during pregnancy (early and late) and two time points post partum (between 6 weeks and 12 weeks and at 12 months). Outcomes analysed included changes in HBV DNA, hepatitis B e antigen (HBeAg) status and flares of hepatitis.

Results One hundred and twenty-six women were recruited. Twenty-seven women out of 108 with postpartum bloods (25%) met our definition of a postpartum flare (ALT range 38–1654). Using univariate analysis HBeAg status, younger age, gravida and parity were associated with a flare. On multivariate analysis HBeAg positivity at baseline fell just outside of statistical significance in predicting a postpartum flare (p=0.051).

Conclusions 25% of women with chronic hepatitis B will demonstrate increased liver inflammation in the postpartum period. This is usually asymptomatic and resolves spontaneously. This is more likely if the woman is HBeAg-positive at baseline (2.56 times the risk), although flares also commonly occur in HBeAg-negative women.

作者: StephenW 时间: 2015-10-9 22:54

肠道2015年; 64：1810至1815年DOI：10.1136 / gutjnl-2014-308211

肝病

原创文章

肝爆发孕妇患有慢性乙型肝炎的临床和病毒学预测

米歇尔Giles1,2,3，库马尔Visvanathan3,4，沙龙Lewin1,5，斯科特Bowden6，斯蒂芬Locarnini6，添Spelman1，乔Sasadeusz1,7

+
作者机构

传染病，阿尔弗雷德医院和莫纳什大学，墨尔本，维多利亚，澳大利亚教研室
传染病教研室，皇家妇女医院，墨尔本，维多利亚，澳大利亚
3Monash传染病，莫纳什健康，墨尔本，维多利亚，澳大利亚
医药，圣文森医院，墨尔本大学，墨尔本，澳大利亚维多利亚州4Department
5Centre生物医学研究，地榆研究所，墨尔本，维多利亚，澳大利亚
6Victorian传染病参考实验室，皇家墨尔本医院的彼得·多尔蒂研究所感染与免疫，墨尔本，维多利亚，澳大利亚
7Victorian传染病服务，皇家墨尔本医院的彼得·多尔蒂研究所感染与免疫，墨尔本，维多利亚，澳大利亚

通讯作者米歇尔博士贾尔斯，传染病股，阿尔弗雷德医院，二级伯纳特机构，商业路85号，墨尔本，3004澳大利亚; [email protected]

收到的2014年5月
修订2014年13月
接受2014年31月
网上公布的前27 2014年十一月

抽象的

在怀孕期间发生的背景独特的免疫学变化;其影响，对乙肝病毒感染的病毒学和生物化学标记没有很好地建立起来。在免疫学轮廓产后和炎症反应的结果反弹快速变化可能导致肝爆发。

方法：女性慢性乙肝怀孕期间被招募到这个观察研究。在怀孕期间的人口统计和临床数据收集连同病毒学和生物化学参数在两个时间点（早期和晚期）和两个时间点产后（6周和12周和12个月之间时）。分析结果包括改变HBV DNA，乙肝e抗原（HBeAg）状态和肝炎发作。

结果一百二十六名妇女被招募。二十七名妇女出108产后血液（25％），符合我们的产后爆发（ALT范围38-1654）的定义。采用单变量分析HBeAg状态，年龄小，孕妇和奇偶校验都与爆发。多变量分析显示e抗原阳性的基线预测产后爆发（P = 0.051）郊外的统计显着性下降。

结论女性慢性乙型肝炎的25％将展示在产后期增加了肝脏炎症。这通常无症状，会自行消退。这是更有可能，如果女人是HBeAg阳性基线（风险2.56倍），但是爆发也通常发生在HBeAg阴性的妇女。

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