乙型肝炎病毒感染：预防怀孕期间母婴传播和恶化。

StephenW

J Infect Chemother. 2019 Apr 11. pii: S1341-321X(19)30078-9. doi: 10.1016/j.jiac.2019.03.014. [Epub ahead of print]
Hepatitis B virus infection: Prevention of mother-to-child transmission and exacerbation during pregnancy.
Sasagawa Y1, Yamada H2, Morizane M1, Deguchi M1, Shirakawa T1, Morioka I3, Tanimura K1.
Author information

1
    Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan.
2
    Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: [email protected].
3
    Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.

Abstract

The aims of this study were to assess the effect of maternal screening for hepatitis B (HB) virus and a perinatal prevention program of mother-to-child transmission, and to identify clinical characteristics and findings associated with HB exacerbation during pregnancy. This prospective cohort study enrolled 3796 pregnant women and their neonates with informed consent. Pregnant women underwent maternal universal screening for HBs antigen (Ag) in the first trimester. If HBs Ag was positive, serum levels of HBe Ag, alanine transaminase (AST), aspartate aminotransferase (ALT), and HB virus (HBV) DNA were measured. All neonates delivered from HBs Ag-positive women were given HB immune globulin and HB vaccine based on the guidelines of the perinatal prevention program. Of the 3796 pregnant women, 40 (1.05%) tested positive for HBs Ag. Three (7.5%) of the 40 HBs Ag-positive women experienced exacerbation of HBV infection during pregnancy. Serum levels of AST (median 776 vs. 22 mIU/ml, p < 0.01), ALT (median 325 vs. 15 mIU/ml, p < 0.01), and HBV-DNA (median 9.1 vs. 5.4 log copies/ml, p < 0.05), and frequencies of HBe Ag-positive (100% vs. 29.7%, p < 0.05) and symptoms of itching or general fatigue (66.7% vs. 0%, p < 0.01) in three women with exacerbation of HBV infection were significantly higher than those in 37 women without exacerbation. There was no case of mother-to-child transmission, suggesting the perinatal HBV prevention program was effective. Levels of HBe Ag, liver enzymes, and HBV-DNA as well as symptoms of itching and general fatigue should be carefully monitored for HBs Ag-positive women during pregnancy and the postpartum period.

Copyright © 2019 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
KEYWORDS:

Hepatitis B virus; Mother-to-child infection; Pregnancy; Screening

PMID:
    30982723
DOI:
    10.1016/j.jiac.2019.03.014

StephenW

J Infect Chemother。 2019年4月11日.pii：S1341-321X（19）30078-9。 doi：10.1016 / j.jiac.2019.03.014。 [印刷前的电子版]
乙型肝炎病毒感染：预防怀孕期间母婴传播和恶化。
Sasagawa Y1，Yamada H2，Morizane M1，Deguchi M1，Shirakawa T1，Morioka I3，Tanimura K1。
作者信息

1
    日本神户大学大学院医学研究科妇产科
2
    日本神户大学大学院医学研究科妇产科电子地址：[email protected]。
3
    日本东京日本大学医学部儿科与儿童健康系。

抽象

本研究的目的是评估孕产妇筛查对乙型肝炎（HB）病毒和围产期预防母婴传播方案的影响，并确定妊娠期间HB恶化的临床特征和发现。这项前瞻性队列研究为3796名孕妇及其新生儿提供了知情同意书。孕妇在妊娠早期接受母亲普遍筛查HBs抗原（Ag）。如果HBs Ag为阳性，则测量HBe Ag，丙氨酸转氨酶（AST），天冬氨酸氨基转移酶（ALT）和HB病毒（HBV）DNA的血清水平。根据围产期预防计划的指导原则，从HBs Ag阳性妇女分娩的所有新生儿均接种HB免疫球蛋白和HB疫苗。在3796名孕妇中，40名（1.05％）检测出HBs Ag阳性。 40名HBs Ag阳性妇女中有3名（7.5％）在怀孕期间出现HBV感染恶化。血清AST水平（中位数776对22 mIU / ml，p <0.01），ALT（中位数325对15 mIU / ml，p <0.01）和HBV-DNA（中位数9.1对5.4 log拷贝/ ml， 3例HBV恶化的女性HBe Ag阳性率（100％vs。29.7％，p <0.05）和瘙痒或全身疲劳症状（66.7％vs。0％，p <0.01）p <0.05）感染率显着高于37例未发生恶化的女性。没有母婴传播的情况，表明围产期HBV预防计划是有效的。在怀孕期间和产后期间，应仔细监测HBs Ag阳性妇女的HBe Ag，肝酶和HBV-DNA水平以及瘙痒和全身疲劳症状。

版权所有©2019日本化学疗法学会和日本传染病学会。由Elsevier Ltd.出版。保留所有权利。
关键词：

乙型肝炎病毒;母婴传染;怀孕;筛选

结论：
    30982723
DOI：
    10.1016 / j.jiac.2019.03.014