慢性乙型肝炎患者产后肝炎的特点及预测因素

StephenW

Am J Gastroenterol. 2018 Feb 27. doi: 10.1038/s41395-018-0010-2. [Epub ahead of print]
The characteristics and predictors of postpartum hepatitis flares in women with chronic hepatitis B.Yi W1, Pan CQ2, Li MH3, Wan G4, Lv YW5, Liu M1, Hu YH1, Zhang ZY6, Xie Y7.
Author information
1Department of Obstetrics and Gynecology, Beijing Ditan Hospital, Capital Medical University, Beijing, China.2Division of Gastroenterology and Hepatology, Department of Medicine, NYU Langone Health, New York University School of Medicine, New York, NY, USA.3Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China.4Department of Biostatistics, Beijing Ditan Hospital, Capital Medical University, Beijing, China.5Information Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China.6Department of Gynecology and Obstetrics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China. [email protected].7Liver Diseases Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China. [email protected].

AbstractINTRODUCTION: We aimed to characterize postpartum disease flares among treatment-naive mothers with chronic hepatitis B (CHB). CHB mothers were enrolled and compared with non-infected mothers in terms of postpartum alanine aminotransferase (ALT) abnormalities.
METHODS: Demographic, virological, and biochemical parameters were collected up to postpartum week 16, with flares and exacerbations defined as ALT levels 5-10 and >10 times the upper limit of normal, respectively. Outcome assessments included ALT flares or exacerbation and their predictive parameters.
RESULTS: Among 4236 patients enrolled, 869 and 3367 had no infection (group A) and had CHB (group B), respectively. Infected mothers were further stratified into two subgroups by the presence (B1, n = 1928) or absence (B2, n = 1439) of detectable serum levels of hepatitis B virus (HBV) DNA (lowest level of quantitation, 100 IU/mL). A significantly higher frequency of abnormal ALT levels was observed in group B vs. group A (28.27 vs. 20.37%, p < 0.001). ALT events mainly occurred in group B1 (flares, 115/1928, 5.96%; exacerbations, 57/1928, 2.96%). The ALT levels had a bimodal pattern, with peaks at postpartum weeks 3-4 and 9-12. On multivariate analysis, elevated ALT levels and detectable levels of HBV DNA at delivery were independent risk factors for postpartum disease flares. Further subgroup analysis in group B1 demonstrated that a cut-off HBV DNA level of 5 log10 IU/mL at delivery predicted ALT events (positive predictive value, 14.4%; negative predictive value, 98.2%).
CONCLUSIONS: Postpartum ALT level elevation is common in CHB patients. ALT flares or exacerbations are mainly observed in mothers with elevated ALT or HBV DNA levels ≥5 log10 IU/mL at delivery.


PMID:29487412DOI:10.1038/s41395-018-0010-2

StephenW

Am J Gastroenterol。 2018年2月27日。doi：10.1038 / s41395-018-0010-2。 [电子版提前打印]
慢性乙型肝炎患者产后肝炎的特点及预测因素
Yi W1，Pan CQ2，Li MH3，Wan G4，Lv YW5，Liu M1，Hu YH1，Zhang ZY6，Xie Y7。
作者信息

1
    首都医科大学附属北京地坛医院妇产科，北京，中国。
2
    美国纽约纽约大学医学院纽约大学Langone健康系医学系胃肠病学和肝病学系。
3
    首都医科大学附属北京地坛医院肝病中心，北京，中国。
4
    首都医科大学附属北京地坛医院生物统计学系，北京。
五
    首都医科大学附属北京地坛医院信息中心，北京，中国。
6
    首都医科大学附属北京朝阳医院妇产科，北京，中国。 [email protected]。
7
    首都医科大学附属北京地坛医院肝病中心，北京，中国。 [email protected]。

抽象
介绍：

我们旨在描述慢性乙型肝炎（CHB）的初治母亲中产后疾病的特征。就产后丙氨酸转氨酶（ALT）异常而言，CHB母亲被录入并与未感染的母亲进行比较。
方法：

人口统计学，病毒学和生物化学参数收集到产后第16周，耀斑和恶化分别定义为ALT水平5-10和正常上限的10倍以上。结果评估包括ALT波动或恶化及其预测参数。
结果：

入选的4236例患者中，869例和3367例无感染（A组），CHB组（B组）。感染的母亲被进一步分层为两个亚组，其存在（B1，n = 1928）或不存在（B2，n = 1439）的可检测血清乙型肝炎病毒（HBV）DNA水平（最低定量水平，100IU / mL） 。在B组与A组中观察到异常的ALT水平显着更高的频率（28.27比20.37％，p <0.001）。 ALT事件主要发生在B1组（耀斑115/1928,5.96％;恶化57/1928,2.96％）。 ALT水平呈双峰模式，在产后3-4周和9-12周出现高峰。多变量分析显示，ALT水平升高和产生可检测水平的HBV DNA是产后疾病发作的独立危险因素。 B1组的进一步亚组分析表明，在输送时切断的HBV DNA水平为5log10 IU / mL可预测ALT事件（阳性预测值，14.4％;阴性预测值，98.2％）。
结论：

产后ALT水平升高在CHB患者中很常见。主要观察ALT升高或HBV DNA水平升高≥5log10IU / mL的母亲分娩时出现ALT眩晕或恶化。

结论：
    29487412
DOI：
    10.1038 / s41395-018-0010-2