替比夫定治疗妊娠期ALT低水平升高的HBV感染者的效果观察

朱云霞; 王明; 陈煜; 边茜; 邹怀宾; 卓秀平; 孟君; 张世斌

doi:10.3969/j.issn.1001-5256.2017.08.011

替比夫定治疗妊娠期ALT低水平升高的HBV感染者的效果观察

DOI: 10.3969/j.issn.1001-5256.2017.08.011

首都医科大学附属北京佑安医院

基金项目:

北京市丰台区卫生计生系统科学研究项目(2016-64)；

详细信息

中图分类号: R714.251
计量
- 文章访问数: 2323
- HTML全文浏览量: 45
- PDF下载量: 435
- 被引次数: 0
出版历程
- 收稿日期: 2017-05-08
- 出版日期: 2017-08-20

Clinical effect of telbivudine in treatment of pregnant women with hepatitis B virus infection and a low-level increase in alanine aminotransferase

Beijing YouAn Hospital, Capital Medical University

Research funding:

摘要

摘要: 目的评价妊娠期特殊免疫状态下HBV感染产妇采用替比夫定抗病毒治疗的意义。方法回顾性分析2014年1月-2015年10月于首都医科大学附属北京佑安医院建档并分娩的HBs Ag阳性,且HBV DNA>106IU/ml的慢性乙型肝炎患者67例,分为ALT升高<2倍正常值上限抗病毒治疗组29例（A组）;ALT升高≥2倍正常值上限抗病毒治疗组20例（B组）;ALT低水平升高未行抗病毒治疗组18例（C组）,其中A、B两组患者在妊娠12周以后给予替比夫定抗病毒治疗,观察3组孕妇分娩前HBV标志物HBsAg水平、HBeAg水平、肝脏生化指标、药物不良反应及新生儿出生缺陷等变化。计量资料多组间比较采用方差分析;计数资料多组间比较采用χ2检验,不满足χ2检验条件时采用Fisher精确检验。结果 3组患者肝功能复常率及分娩前HBsAg变化情况比较,差异均无统计学意义（P值均>0.05）;3组产妇至分娩前HBV DNA下降≥3个对数的比例分别为44.8%、85.0%、16.7%,HBeAg下降≥50%的比例分别为41.4%、7...
- 肝炎,乙型,慢性 /
- 丙氨酸转氨酶 /
- 妊娠三月期 /
- 治疗 /
- 替比夫定
Abstract: Objective To investigate the clinical effect of antiviral therapy with telbivudine antiviral therapy in parturients with hepatitis B virus ( HBV) infection and a special immune status in pregnancy. Methods A retrospective analysis was performed for the clinical data of67 HBsAg-positive chronic hepatitis B ( CHB) patients with HBV DNA > 106IU/ml who were examined and gave birth in Beijing You An Hospital, Capital Medical University, from January 2014 to October 2015. According to the level of alanine aminotransferase ( ALT) , the patients were divided into ALT < 2 × upper limit of normal ( ULN) group ( 29 patients, group A) , ALT ≥2 × ULN group with antiviral therapy ( 20 patients, group B) , and low-level ALT increase group without antiviral therapy ( 18 patients, group C) . The patients in groups A and B were given antiviral therapy with telbivudine after 12 weeks of pregnancy. The three groups were observed in terms of the levels of HBV markers HBsAg and HBeAg, liver biochemical parameters, adverse drug reactions, and neonatal birth defects. An analysis of variance was used for comparison of continuous data between multiple groups, the chi-square test was used for comparison of categorical data between multiple groups, and the Fisher's exact test was used when the data did not meet the conditions for the chi-square test. Results There were no significant differences between the three groups in normalization rate of liver function and the change in HBsAg level at the time of delivery ( both P > 0. 05) . The proportions of patients who achieved a ≥3 log reduction in HBV DNA level at the time of delivery were 44. 8%, 85. 0%, and 16. 7%, respectively, in the three groups, and the proportions of patients who achieved a ≥50% reduction in HBeAg were 41. 4%, 70. 0%, and 11. 1%, respectively; there were significant differences between the three groups for the two indices ( χ2=19. 85 and 14. 74, both P < 0. 001) . Conclusion The right timing of antiviral therapy for pregnant women with a low-level increase in ALT can effectively reduce the risk of mother-to-child transmission.
- hepatitis B, chronic /
- alanine transaminase /
- pregnancy trimesters /
- therapy /
- telbivudine

HTML全文

参考文献(16)

[1]ZHANG H, PAN CQ, PANG Q, et al.Telbivudine or lamivudine use in late pregnancy safely reduces perinatal transmission of hepatitis B virus in real-life practice[J].Hepatology, 2014, 60 (2) :468-476.

[2]LAMBERTH JR, REDDY SC, PAN JJ, et al.Chronic hepatitis B infection in pregnancy[J].World J Hepatol, 2015, 7 (9) :1233-1237.

[3]CHEN YC, CHUEH HY, LIAW YF.Chronic hepatitis B virus infection with acute exacerbation during pregnancy:a case control study[J].Hepatol Int, 2013, 7:s244-s245.

[4]DIAO JC, GAN N.Abnormal liver function and relationship with pregnancy complications or influence of perinatals[J].Anhui Med J, 2011, 32 (6) :782-784. (in Chinese) 刁俊春, 干宁.肝功能异常与妊娠并发症的关系及对围生儿的影响[J].安徽医学, 2011, 32 (6) :782-784.

[5]FU D, LI ZH, LIU M, et al.Influence of antiviral therapy on pregnancy outcome in active hepatitis B patients during pregnancy[J].ADRJ, 2012, 14 (3) :149-153. (in Chinese) 付冬, 李振华, 刘敏, 等.孕期乙型肝炎活动患者抗病毒治疗对妊娠结局的影响[J].药物不良反应杂志, 2012, 14 (3) :149-153.

[6]ZENG DW, DONG J, CHEN LH, et al.Relation between HBs Ag levels during the immune clearance phase of hepatitis B virus infection and liver pathological stages of chronic hepatitis B[J].Chin J Hepatol, 2012, 20 (10) :746-750. (in Chinese) 曾达武, 董菁, 陈丽红, 等.免疫清除期慢性乙型肝炎患者血清HBs Ag水平与肝组织炎症分级及纤维化分期的关系[J].中华肝脏病杂志, 2012, 20 (10) :746-750.

[7] CHEN CJ, YANG HI, SU J, et al.Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level[J].JAMA, 2006, 295 (1) :65-73.

[8]MARTINOT-PEIGNOUX M, LAPALUS M, ASSELAH T, et al.The role of HBs Ag quantification for monitoring natural history and treatment outcome[J].Liver Int, 2013, 33 (Suppl 1) :125-132.

[9]YANG CG, YU YC, GHEN JJ, et al.A comparison of clinical and virological characteristics of 1686 cases of HBe Ag-negative and HBe Ag-positive chronic hepatitis B[J].Chin J Intern Med, 2005, 44 (9) :648-651. (in Chinese) 杨创国, 于乐成, 陈金军, 等.1686例慢性乙型肝炎中HBe Ag阴性与阳性患者临床和病毒学特点比较分析[J].中华内科杂志, 2005, 44 (9) :648-651.

[10]FAN HM, YANG Z, ZHANG CL, et al.Liver histopathological features of chronic HBV carriers and inactive HBs Ag carriers[J].Chin J Hepatol, 2007, 15 (5) :334-337. (in Chinese) 范慧敏, 杨湛, 张春兰, 等.乙型肝炎病毒携带者的肝脏病理学特点[J].中华肝脏病杂志, 2007, 15 (5) :334-337.

[11]BRUETTO MR.A new role for an old marker, HBs Ag[J].J Hepatol, 2010, 52 (4) :475-477.

[12]NGUYEN T, THOMPSON AJ, BOWDEN S, et al.Hepatitis B surface antigen levels during the natural history of chronic hepatitis B:a perspective on Asia[J].J Hepatol, 2010, 52 (4) :508-513.

[13]JAROSZEWICZ J, CALLE SERRANO B, WURSTHORN K, et al.Hepatitis B surface antigen (HBs Ag) levels in the natural history of hepatitis B virus (HBV) -infection:a European perspective[J].J Hepatol, 2010, 52 (4) :514-522.

[14]CHAN HL, WONG VW, WONG GL, et al.A longitudinal study on the natural history of serum hepatitis B surface antigen changes in chronic hepatitis B[J].Hepatology, 2010, 52 (4) :1232-1241.

[15]JUNG YK, KIM JH, LEE YS, et al.Change in serum hepatitis B surface antigen level and its clinical significance in treatment-na6ve, hepatitis B e antigen-positive patients receiving entecavir[J].J Clin Gastroenterol, 2010, 44 (9) :653-657.

[16]WURSHORN K, JUNG M, RIVA A, et al.Kinetics of hepatitis B surface antigen decline during 3 years of telbivudine treatment in hepatitis B e antigen-positive patients[J].Hepatology, 2010, 52 (5) :1611-1620.

施引文献

资源附件(0)

访问统计