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慢性HBV感染孕妇妊娠期及分娩后病毒学和肝功能变化的特点及机制

赵梦鱼 邹怀宾 陈煜 郑素军 段钟平

引用本文:
Citation:

慢性HBV感染孕妇妊娠期及分娩后病毒学和肝功能变化的特点及机制

DOI: 10.3969/j.issn.1001-5256.2019.06.038
基金项目: 

国家科技重大专项“艾滋病和病毒性肝炎等重大传染病防治”(2017ZX10201201-001-001,2017ZX10201201-002-002); 北京市科学技术委员会资助(Z151100003915096,Z161100000516084); 

详细信息
  • 中图分类号: R714.251

Characteristics and mechanism of virological and liver function changes in pregnant women with chronic hepatitis B virus infection during pregnancy and after delivery

Research funding: 

 

  • 摘要: HBV感染的孕妇妊娠期间自身机体的变化(体内激素水平及免疫状态)或抗病毒治疗后停药等均可能会导致病毒学改变及肝功能异常,严重者可导致不良结局。因此,加强对慢性HBV感染孕妇妊娠期及分娩后的病毒学指标及肝功能的监测有助于及时发现孕妇机体变化情况,从而避免肝炎发作甚至重型肝炎等不良后果的发生。现就慢性HBV感染孕妇妊娠期及分娩后病毒学及肝功能变化的特点及机制的文献作一综述,为提高临床医生对慢性HBV感染的孕妇妊娠期及分娩后管理水平提供理论支持。

     

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  • 收稿日期:  2018-12-11
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