基线乙型肝炎病毒滴度预测最初的产后肝火张：多中心前瞻

StephenW

J Clin Gastroenterol. 2017 Jun 26. doi: 10.1097/MCG.0000000000000877. [Epub ahead of print]
Baseline Hepatitis B Virus Titer Predicts Initial Postpartum Hepatic Flare: A Multicenter Prospective Study.Liu J1, Wang J, Qi C, Cao F, Tian Z, Guo D, Yan T, Li Q, Yang S, Fu J, Tang X, Kou X, Liu N, Jiang Z, Zhao Y, Chen T.
Author information
1Departments of *Infectious Disease †Rheumatology and Immunology ‡Gynaecology and Obstetrics §Neonatology, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.

AbstractBACKGROUND AND GOALS: A series of changes in the immune system occur during pregnancy and puerperium. Currently, we aim to characterize both the natural changes in liver inflammation and its association with hepatitis B viremia during this special period.
PATIENTS AND METHODS: Chronic hepatitis B (CHB) gravidas were recruited and followed up to 52 weeks postpartum. Virological and biochemical parameters were assessed throughout the period.
RESULTS: A total of 1097 CHB mothers had finished the entire follow-up including 451 accepting telbivudine, 178 accepting tenofovir, and 468 without antiviral therapy. Among the mothers, 11.94% went through hepatic flare in the first trimester and the rate decreased to 2.1% at the time of delivery. Nevertheless, a much higher frequency (19.78%) was observed in the early postpartum. Interestingly, alanine aminotransferase level decreased along with the development of pregnancy and then suddenly increased in the first month of puerperium. In addition, a downward trend was observed on the titer of HBsAg and HBeAg after delivery. Of note, an obvious higher frequency of alanine aminotransferase flare was revealed in mothers with high viremia (>6 log10 IU/mL). With multivariate analysis, only hepatitis B virus titer at baseline was strongly associated with hepatic flare during early postpartum (95% confidence interval, 1.012-3.049, P=0.045). The predictive rates of hepatic flare at baseline viral load of 6, 7, and 8 log10 IU/mL were 16.67%, 28.30%, and 30.60%, respectively.
CONCLUSIONS: CHB gravidas with high viremia should be monitored closely during entire pregnancy, and extended antiviral therapy is recommend to those mothers with baseline viremia >7 log10 IU/mL.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/.


PMID:28654554DOI:10.1097/MCG.0000000000000877

StephenW

Clin Gastroenterol。 2017年6月26日。doi：10.1097 / MCG.0000000000000877。 [提前印刷]
基线乙型肝炎病毒滴度预测最初的产后肝火张：多中心前瞻性研究。
刘杰1，王杰，齐克，曹福田，田德，郭德，严婷，李Q，杨S，傅J，唐旭，寇X，刘N，姜泽赵钊陈
作者信息

1
    传染病部门†风湿病与免疫学‡妇科与产科§西安交通大学第一附属医院鼻咽科，陕西西安。

抽象
背景与目标：

免疫系统的一系列变化发生在怀孕和产褥期间。目前，我们的目标是在这个特殊时期，描述肝脏炎症的自然变化及其与乙型肝炎病毒血症的关系。
患者和方法：

招募慢性乙型肝炎（CHB）妊娠，随后产后52周。在整个期间评估病毒学和生物化学参数。
结果：

共有1097名CHB母亲完成了整个随访，其中451例接受替比夫定，178例接受替诺福韦，468例无抗病毒治疗。母亲中，11.94％在妊娠前期发生肝功能异常，发病时下降至2.1％。然而，在产后早期观察到频率高得多（19.78％）。有趣的是，丙氨酸氨基转移酶水平随妊娠发展而下降，然后在产后第一个月突然增加。此外，HBsAg和HBeAg在分娩后滴度呈下降趋势。值得注意的是，病毒血症高（> 6 log10 IU / mL）的母亲中，丙氨酸氨基转移酶闪烁频率明显增高。通过多变量分析，仅在基线时乙型肝炎病毒滴度与产后早期肝功能亢进密切相关（95％置信区间，1.012-3.049，P = 0.045）。 6,7和8 log10 IU / mL基线病毒载量时肝脏闪烁的预测率分别为16.67％，28.30％和30.60％。
结论：

在整个怀孕期间，应严密监测具有高病毒血症的CHB妊娠，并向基线病毒血症> 7 log10 IU / mL的母亲推荐延长的抗病毒治疗。这是根据知识共享署名 - 非公开条款分发的开放获取文章商业 - 无衍生品许可证4.0（CCBY-NC-ND），允许下载和共享工作，只要它被正确引用。未经书面许可，不得以任何方式改变工作或商业用途。 http://creativecommons.org/licenses/by-nc-nd/4.0/。

结论：
    28654554
DOI：
    10.1097 / MCG.0000000000000877