HBeAg识别有可能将乙肝病毒传播给新生儿的孕妇的准确性：系

StephenW

Accuracy of HBeAg to identify pregnant women at risk of transmitting hepatitis B virus to their neonates: a systematic review and meta-analysis

    Pauline Boucheron, MD
    Ying Lu, PhD
    Kyoko Yoshida
    Tianshuo Zhao, MSc
    Anna L Funk, PhD
    Prof Françoise Lunel-Fabiani, MD
    et al.
    Show all authors

Published:August 14, 2020DOI:https://doi.org/10.1016/S1473-3099(20)30593-4
PlumX Metrics

    Summary
    References
    Article Info
    Linked Articles

Summary
Background
Prevention of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) involves neonatal immunoprophylaxis, with a birth dose of hepatitis B vaccine and immune globulin, and provision of peripartum antiviral prophylaxis in highly viraemic women. However, access to assays to quantify HBV DNA levels remains inadequate in resource-poor settings. This study was commissioned by WHO and aimed to identify the HBV DNA threshold for MTCT, to assess the sensitivity and specificity of hepatitis B e antigen (HBeAg) testing to identify pregnant women with HBV DNA levels above this threshold, and to predict MTCT of HBV infection on the basis of HBeAg testing.
Methods
For this systematic review and meta-analysis, we searched the PubMed, EMBASE, Scopus, CENTRAL, CNKI, and Wanfang databases for studies of pregnant women with chronic HBV infection without concurrent antiviral therapy, published between Jan 1, 2000, and April 3, 2019. Studies were eligible for inclusion if MTCT in mother–child pairs could be stratified by different levels of maternal HBV DNA during pregnancy, if maternal HBeAg status could be stratified by HBV DNA level, and if the MTCT status of infants could be stratified by maternal HBeAg status during pregnancy. Studies that selected pregnant women on the basis of HBeAg serostatus or HBV DNA levels were excluded. Aggregate data were extracted from eligible studies by use of a pre-piloted form; study authors were contacted to clarify any uncertainties about potential duplication or if crucial information was missing. To pool sensitivities and specificities of maternal HBeAg to identify highly viraemic women and to predict MTCT events, we used the DerSimonian-Laird bivariate random effects model. This study is registered with PROSPERO, CRD42019138227.
Findings
Of 9007 articles identified, 67 articles (comprising 66 studies) met the inclusion criteria. The risk of MTCT despite infant immunoprophylaxis was negligible (0·04%, 95% CI 0·00–0·25) below a maternal HBV DNA level of 5·30 log 10 IU/mL (200 000 IU/mL) and increased above this threshold. The pooled sensitivity of HBeAg testing to identify HBV DNA levels of 5·30 log 10 IU/mL or greater in pregnant women was 88·2% (83·9–91·5) and pooled specificity was 92·6% (90·0–94·5). The pooled sensitivity of HBeAg testing in predicting MTCT of HBV infection despite infant immunoprophylaxis was 99·5% (95% CI 91·7–100) and pooled specificity was 62·2% (55·2–68·7).
Interpretation
Maternal HBV DNA of 5·30 log 10 IU/mL or greater appears to be the optimal threshold for MTCT of HBV infection despite infant immunoprophylaxis. HBeAg is accurate to identify women with HBV DNA levels above this threshold and has high sensitivity to predict cases of immunoprophylaxis failure. In areas where HBV DNA assays are unavailable, HBeAg can be used as an alternative to assess eligibility for antiviral prophylaxis.
Funding
World Health Organization.

StephenW

HBeAg识别有可能将乙肝病毒传播给新生儿的孕妇的准确性：系统的回顾和荟萃分析

    Pauline Boucheron，医学博士
    陆颖博士
    吉田恭子
    赵天硕理学硕士
    Anna L Funk博士
    医学博士FrançoiseLunel-Fabiani
    等。
    显示所有作者

发布时间：2020年8月14日DOI：https：//doi.org/10.1016/S1473-3099（20）30593-4
PlumX指标

    摘要
    参考资料
    文章信息
    链接文章

摘要
背景
预防乙型肝炎病毒（HBV）的母婴传播（MTCT）涉及新生儿免疫预防，出生剂量的乙型肝炎疫苗和免疫球蛋白，以及在高病毒血症女性中提供围产期抗病毒预防。但是，在资源匮乏的环境中，无法获得用于量化HBV DNA水平的检测方法的机会。这项研究是由世界卫生组织委托进行的，旨在确定MTCT的HBV DNA阈值，评估乙型肝炎e抗原（HBeAg）检测的敏感性和特异性，以鉴定HBV DNA水平高于该阈值的孕妇，并预测HBV的MTCT根据HBeAg检测确定感染。
方法
为了进行系统的审查和荟萃分析，我们搜索了PubMed，EMBASE，Scopus，CENTRAL，CNKI和Wanfang数据库，以研究未同时进行抗病毒治疗的慢性HBV感染孕妇的研究，该研究于2000年1月1日至4月3日发表， 2019.如果母婴对中的MTCT可以通过怀孕期间母体HBV DNA的不同水平进行分层，如果母体HBeAg状况可以通过HBV DNA的水平进行分层，并且婴儿的MTCT状况可以进行分层，则可以纳入研究通过孕期孕妇的HBeAg状态。排除根据HBeAg血清状况或HBV DNA水平选择孕妇的研究。通过使用预试表格从符合条件的研究中提取总数据；与研究作者联系以澄清有关潜在重复的任何不确定性或关键信息是否丢失。为了汇总母体HBeAg的敏感性和特异性以鉴定高病毒血症女性并预测MTCT事件，我们使用了DerSimonian-Laird双变量随机效应模型。该研究已在PROSPERO注册，注册号为CRD42019138227。
发现
在确定的9007篇文章中，有67篇文章（包括66项研究）符合纳入标准。母体HBV DNA水平低于5.30 log 10 IU / mL（200 000 IU / mL）时，尽管婴儿进行了免疫预防，MTCT的风险可忽略不计（0·04％，95％CI 0·00-0·25）阈。孕妇HBeAg检测的HBV DNA鉴定为5.30 log 10 IU / mL或更高的合并敏感性为88·2％（83·9–91·5），合并特异性为92·6％（90·0– 94·5）。尽管婴儿进行了免疫预防，HBeAg检测对预测HBV感染MTCT的合并敏感性为99·5％（95％CI 91·7-100），合并特异性为62.2％（55·2–68·7）。
解释
尽管婴儿进行了免疫预防，但5.30 log 10 IU / mL或更高的孕妇HBV DNA似乎是MTCT HBV感染的最佳阈值。 HBeAg可以准确地识别HBV DNA水平高于该阈值的女性，并且对预测免疫预防失败的病例具有很高的敏感性。在无法进行HBV DNA检测的地区，可以使用HBeAg作为评估抗病毒预防资格的替代方法。
资金
世界卫生组织。