血清谷丙转氨酶和乙肝DNA耀斑在孕妇和产后妇女慢性乙型肝

StephenW

Am J Gastroenterol 2016; 111:1410–1415; doi:10.1038/ajg.2016.296; published online 26 July 2016
Serum Alanine Aminotransferase and Hepatitis B DNA Flares in Pregnant and Postpartum Women with Chronic Hepatitis B

Christine Y Chang BS1,2, Natali Aziz MD, MSc3, Mugilan Poongkunran MD4, Asad Javaid MD4, Huy N Trinh MD5, Daryl Lau MD, MSc, MPH4 and Mindie H Nguyen MD, MAS1

    1Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
    2University of California, Los Angeles School of Medicine, Los Angeles, California, USA
    3Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
    4Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
    5San Jose Gastroenterology, San Jose, California, USA

Correspondence: Mindie H Nguyen, MD, MAS, Division of Gastroenterology and Hepatology, Stanford University Medical Center, 750 Welch Road, Suite 210, Palo Alto, California 94304, USA. E-mail: [email protected]

Received 1 January 2016; Accepted 9 June 2016
Advance online publication 26 July 2016
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Abstract
OBJECTIVES:

Alterations in the immune system during pregnancy have been associated with reactivation of hepatitis B virus (HBV) in chronic hepatitis B (CHB) women. However, the effects of pregnancy on CHB remain not well understood. The goal of this study was to examine flares in HBV DNA and serum alanine aminotransferase (ALT) during pregnancy and postpartum in CHB women untreated prior to pregnancy.
METHODS:

This was a multicenter retrospective study of 113 pregnancies in 101 CHB women who presented during pregnancy at two community gastroenterology clinics and two tertiary medical centers in the United States during 1997–2015. Outcomes analyzed included onset, severity, and resolution of flares in HBV and ALT that occurred prior to starting antiviral therapy, if antiviral therapy was subsequently initiated. Women who initiated antiviral therapy during pregnancy were not included in the analysis of postpartum flares.
RESULTS:

HBV DNA flares were observed in 9% (8/90) of women during pregnancy and 4% (2/48) of women during postpartum. Flares in ALT (99–2522 U/l) were observed in 6% (7/112) of women during pregnancy and 10% (5/51) of women within the first 3 months of delivery. Age, HBeAg positivity, baseline HBV DNA, baseline ALT, gravida, and parity were not found to be significant predictors of flare.
CONCLUSIONS:

Flares in HBV DNA and ALT can occur during late pregnancy and early postpartum in CHB women, and can be severe. Women with CHB should therefore be closely monitored during pregnancy and early postpartum.

StephenW

牛J Gastroenterol 2016年; 111：1410至1415年; DOI：10.1038 / ajg.2016.296;网上公布的26月2016年
血清谷丙转氨酶和乙肝DNA耀斑在孕妇和产后妇女慢性乙型肝炎

恭ÿ昌BS1,2，纳塔利·阿齐兹博士，MSC3，Mugilan Poongkunran MD4，阿萨德Javaid MD4，伊ñ郑氏MD5，达里尔刘医学博士，硕士，MPH4和Mindieħ阮医师，MAS1

    胃肠病学和肝病，斯坦福大学医学中心，帕洛阿尔托，加利福尼亚州，美国的1区
    加州医学洛杉矶分校，洛杉矶，美国加利福尼亚州的2University
    3Obstetrics妇产科，医学院，斯坦福大学，美国加利福尼亚州斯坦福大学医学院
    消化4Division，贝斯以色列女执事医疗中心，哈佛大学医学院，波士顿，马萨诸塞州，美国
    5San何塞消化内科，圣何塞，加利福尼亚，美国

函授：Mindieħ阮，MD，MAS，消化内科和肝病，斯坦福大学医学中心，750韦尔奇道，套房210，加利福尼亚州帕洛阿尔托94304，USA的分部。电子信箱：[email protected]

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抽象
目的：

在怀孕期间免疫系统中的变化已经与在慢性乙型肝炎（CHB）的妇女乙型肝炎病毒（HBV）的激活相关联。但是，妊娠对慢性乙型肝炎的效果仍不甚了解。这项研究的目的是未经处理怀孕前和孕期产后女性CHB过程中，检查HBV DNA和血清谷丙转氨酶（ALT）耀斑。
方法：

这是在101 CHB女性怀孕113怀孕期间的两个社区诊所胃肠病和两个三级医疗中心在美国期间，1997至2015年谁提出了多中心回顾性研究。结果分析了包括发作，严重性，并在HBV和ALT升高之前开始抗病毒治疗，如果抗病毒治疗，随后启动时发生的分辨率。谁在怀孕期间发起的抗病毒治疗的妇女并没有包括在产后耀斑的分析。
结果：

在怀孕期间和产后的妇女的4％（2/48），在女性的9％（九十○分之八）观察HBV DNA耀斑。妇女怀孕和10％（51分之5）期间，女性6％（112分之7）观察前3个月内交货的ALT（99-2522 U / L）耀斑。年龄，e抗原阳性，基线HBV DNA，基线ALT，孕妇和奇偶均未发现耀斑的显著预测。
结论：

在HBV DNA和ALT耀斑可以妊娠后期和产后早期慢性乙型肝炎的女性中发生，并且可能是严重的。妇女CHB因此应该在怀孕早期产后期间进行密切监测