上升HBV DNA，ALT在怀孕，产后妇女常见

StephenW

Flares in HBV DNA, ALT common in pregnant, postpartum women

Chang CY, et al. Am J Gastroenterol. 2016;doi:10.1038/ajg.2016.296.

August 17, 2016

     
Pregnant and postpartum women with chronic hepatitis B virus infection can experience severe flares in HBV DNA and alanine aminotransferase, according to recent findings.

“In our multi-center study of pregnant women with chronic hepatitis B, significant increases in hepatitis B DNA and alanine aminotransferase (ALT) were fairly common, mostly during late second trimester and after or shortly after delivery,” Mindie H. Nguyen, MD, MAS, AGAF, FAASLD, director of the hepatology fellowship and hepatology clerkship at Stanford University Medical Center, told Infectious Disease News. “Though rare, a few of these hepatitis flares led to severe hepatic decompensation.”

Nguyen and colleagues, including Christine Y. Chang, BS, division of gastroenterology and hepatology, Stanford University Medical Center, conducted a retrospective study of 113 pregnancies in 101 women with chronic HBV seen during pregnancy at two community gastroenterology clinics and two tertiary medical centers from 1997 to 2015. The researchers sought to examine the onset, severity and resolution of flares in HBV and ALT.

“In contrast to prior studies, our work included women with both low and high viral loads, and focused on maternal outcomes,” Nguyen said.


Women who initiated antiviral therapy for HBV during pregnancy were excluded in the analysis of postpartum flares. Nine percent of women experienced HBV DNA flares during pregnancy (eight of 90), and 4% had flares during postpartum (two of 48). ALT flares — classified as between 99 U/L (minimum 5x upper limit of normal) and 2,522 U/L — were experienced by 6% of women during pregnancy (seven of 112) and 10% of women within 3 months’ postpartum (five of 51).

Antiviral therapy was initiated in 28 pregnancies at 28 weeks of pregnancy. Of these women in both groups, two continued treatment during postpartum, and three discontinued treatment at delivery; they all experienced subsequent flares in ALT (between 180 U/L and 1,429 U/L) within the first 3 months’ postpartum.

The researchers noted that most of the women who had increases in HBV DNA during pregnancy and not treated during postpartum returned to baseline HBV DNA levels. Some who remained untreated or discontinued antiviral therapy at delivery, however, sustained HBV DNA levels lower vs. baseline for 3 months to 1 year after delivery.

“This suggests that immunological changes during pregnancy, rather than antiviral therapy itself, may stimulate immunoseroclearance, and would support the higher-than-expected rates of HBeAg seroconversion previously reported in [chronic HBV] pregnant women,” the researchers wrote.

Univariate analysis determined age, hepatitis B e antigen positivity, baseline HBV DNA, baseline ALT, gravida and parity were not significant predictors of flares in this patient population. Nguyen said predictive factors for flares have not been consistently identified, suggesting the need for further research.

“Close monitoring of these patients during late pregnancy and early postpartum should be performed, as flares can be symptomatic and/or warrant antiviral therapy for prevention of hepatic decompensation in mothers as well as prevention of vertical transmission of HBV to infants. Further research is needed to characterize the effects of pregnancy on hepatitis B and help physicians manage the disease during pregnancy,” Nguyen said. – by Melinda Stevens

Disclosure: Nguyen reports receiving research support from Bristol-Myers Squibb, Gilead Sciences, Janssen Pharmaceuticals and the National Cancer Institute, and serving on the advisory boards at Alnylam Pharmaceuticals, Bristol-Myers Squibb, Gilead Sciences, Intercept Pharmaceuticals, Janssen Pharmaceuticals, and Roche Laboratories. Please see the full study for a list of all other researchers’ relevant financial disclosures.

StephenW

耀斑中HBV DNA，ALT在怀孕，产后妇女常见
常CY，等。牛J Gastroenterol。 2016年，DOI：10.1038 / ajg.2016.296。

2016年8月17日

     
孕妇和产后妇女的慢性乙肝病毒感染可在HBV DNA和丙氨酸氨基转移酶遇到严重的耀斑，根据最近的调查结果。

“在我们的孕妇患有慢性乙型肝炎的多中心研究，乙肝DNA和丙氨酸氨基转移酶（ALT）升高显著是相当普遍的，大部分是在晚孕中期后或交付后不久，”Mindie H.阮，MD ，MAS，AGAF，FAASLD的肝病奖学金和肝病见习斯坦福大学医疗中心的主任，告诉传染病新闻。 “虽然数量很少，其中的一些肝炎爆发导致了严重的肝功能失代偿。”

阮和他的同事，包括克里斯汀Y.张，BS，胃肠病学和肝病，斯坦福大学医学中心的划分，在101女性进行了113怀孕了回顾性研究与两个社区胃肠病诊所和两个三级甲等医院怀孕期间见到的慢性HBV 1997年至2015年，研究人员试图检查HBV和ALT发作，严重程度和耀斑的分辨率。

“相对于以前的研究中，我们的工作包括妇女低和高病毒载量，并专注于孕产妇结局，”阮说。


谁在怀孕期间开始抗病毒治疗乙肝女性被排除在产后耀斑的分析。女性的百分之九妊娠（90 8）期间经历HBV DNA信号弹和4％，产后（两个48）期间耀斑。 ALT耀斑 - 归类为99 U / L（正常最小5倍上限）和2522 U / L之间 - 女性的6％妊娠（112 7件）和3个月的产后内10％的女性（五期间分别经历的51）。

抗病毒治疗是在怀孕28在妊娠28周开始。这些妇女在这两个群体中，有两个产后继续治疗期间，在交期三大停产治理;他们都经历了ALT耀斑以后的前3个月内产后（180 U / L和1429 U / L之间）。

研究人员指出，大多数谁在怀孕期间曾在HBV DNA升高期间和产后不治疗的女性回到基线HBV DNA水平。一些然而谁在输送保持未处理或停产抗病毒治疗，，低级持续HBV DNA水平与基线3个月至1年分娩后。

“这表明，在怀孕期间免疫学变化，而不是抗病毒治疗本身，可能会刺激immunoseroclearance，并支持此前在[慢性乙肝]孕妇报道HBeAg血清学转换的比预期更高的利率，”研究人员写道。

单因素分析确定年龄，乙肝e抗原阳性，基线HBV DNA，基线ALT，孕妇和奇偶校验都不在患者群耀斑显著预测。阮说，耀斑预测因素尚未确定一致，这为进一步研究的必要。

“应进行妊娠后期和产后早期在这些病人的密切监测，如耀斑可对症和/或保证对母亲预防肝功能失代偿的抗病毒治疗以及预防婴儿乙肝病毒垂直传播。需要进一步的研究来表征乙肝和帮助医生在怀孕期间控制疾病妊娠的影响，“阮说。 - 通过梅林达·史蒂文斯

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