慢性乙型肝炎孕妇临床和病毒学预测肝 ALT升高

StephenW

Gut doi:10.1136/gutjnl-2014-308211

    Hepatology

    Original article

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

    Michelle Giles1,2,3,
    Kumar Visvanathan3,4,
    Sharon Lewin1,5,
    Scott Bowden6,
    Stephen Locarnini6,
    Tim Spelman1,
    Joe Sasadeusz1,7

+ 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.

StephenW

肠道DOI：10.1136/ gutjnl-2014-308211

    肝病

    原创文章

肝耀斑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，
    蒂姆Spelman1，
    乔Sasadeusz1,7

+作者所属机构

    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，维多利亚，澳大利亚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

    对应医生米歇尔·贾尔斯，传染病单位，Alfred Hospital医院，二级地榆研究所，商业路85号，墨尔本，VIC3004，澳大利亚; [email protected]

    收到的2014年8月5日
    修订后的2014年10月13日
    接受2014年10月31日
    网上公布的第一2014年11月27日

抽象

背景
怀孕期间发生的独特的免疫学变化;其中的影响，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随后反弹的快速变化，可能会导致肝耀斑。

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个月之间的）。结果分析，包括改变HBV DNA，乙肝e抗原（HBeAg）状态和肝炎发作。

结果
一百26妇女被招募。二十七名妇女出108产后血液（25％），符合我们的产后耀斑（ALT范围38-1654）的定义。使用单因素分析HBeAg状态，年龄小，孕妇和奇偶均与耀斑。多变量分析大三阳阳性的基线预测产后耀斑（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。这是通常无症状，并解决油然而生。这是更容易，如果女人是HBeAg阳性基线（风险2.56倍），但也耀斑通常发生在HBeAg阴性的妇女。