妊娠对慢性HBV感染自然史的影响

陈雨欣; 黄睿; 吴超

doi:10.3969/j.issn.1001-5256.2019.07.004

妊娠对慢性HBV感染自然史的影响

DOI: 10.3969/j.issn.1001-5256.2019.07.004

南京大学医学院附属鼓楼医院感染科

详细信息

中图分类号: R714.251
计量
- 文章访问数: 1410
- HTML全文浏览量: 56
- PDF下载量: 376
- 被引次数: 0
出版历程
- 收稿日期: 2019-05-07
- 出版日期: 2019-07-20

Influence of pregnancy on the natural history of chronic hepatitis B virus infection

Department of Infectious Diseases, Affiliated Drum Tower Hospital of Nanjing University Medical School

摘要

摘要: 慢性HBV感染依然是我国严重的公共卫生问题,其中我国孕妇HBsAg携带率高达6. 0%～7. 8%。妊娠期间,母体免疫系统处于抑制状态,进而可能会影响HBV感染的自然史。目前,妊娠对HBV感染自然史的影响尚无定论。从妊娠期内母体的免疫抑制现象和妊娠对慢性HBV感染者体内病毒复制、HBeAg血清学转换、肝功能及肝脏疾病进程的影响等方面,综述了妊娠对慢性HBV感染自然史的影响相关的研究进展,并建议临床应当密切监测慢性HBV感染的孕妇在妊娠期和产后的病毒学和肝功能实验室检查。
- 乙型肝炎病毒 /
- 妊娠 /
- 治疗学 /
- 孕妇
Abstract: Chronic hepatitis B virus ( HBV) infection is still a serious public health problem in China, and the HBsAg carrying rate reaches6. 0%-7. 8% in pregnant women. Maternal immune system is suppressed during pregnancy, which may affect the natural history of HBV infection. At present, no consensus has been reached on the influence of pregnancy on the natural history of HBV infection. The article reviews the research advances in the influence of pregnancy on the natural history of HBV infection from the aspects of maternal immunosuppression during pregnancy and the effect of pregnancy on viral replication, HBeAg seroconversion, liver function, and liver disease progression. Pregnant women with chronic HBV infection should be closely monitored in clinical practice in terms of virological examination and liver function examination during pregnancy and postpartum.
- hepatitis B virus /
- pregnancy /
- therapeutics /
- pregnant women

HTML全文

参考文献(40)

[1] CUI F, SHEN L, LI L, et al. Prevention of chronic hepatitis B after 3 decades of escalating vaccination policy, China[J].Emerg Infect Dis, 2017, 23 (5) :765-772.

[2] Chinese Society of Hepatology and Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B:A 2015 update[J]. J Clin Hepatol, 2015, 31 (12) :1941-1960. (in Chinese) 中华医学会肝病学分会, 中华医学会感染病学分会.慢性乙型肝炎防治指南 (2015年更新版) [J].临床肝胆病杂志, 2015, 31 (12) :1941-1960.

[3] GUO Y, LIU J, MENG L, et al. Survey of HBsAg-positive pregnant women and their infants regarding measures to prevent maternal-infantile transmission[J]. BMC Infect Dis, 2010, 10:26.

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

[5] TER BORG MJ, LEEMANS WF, de MAN RA, et al. Exacerbation of chronic hepatitis B infection after delivery[J]. J Viral Hepat, 2008, 15 (1) :37-41.

[6] TROWSDALE J, BETZ AG. Mother's little helpers:Mechanisms of maternal-fetal tolerance[J]. Nat Immunol, 2016, 7 (3) :241-246.

[7] HUANG HF, HE DM, WU QX, et al. Changes in serum levels of Th1/Th2 cytokines in HBe Ag-positive pregnant women with HBV infection after telbivudine treatment[J]. J Clin Hepatol, 2014, 30 (6) :522-526. (in Chinese) 黄鸿菲, 何登明, 吴全新, 等. HBe Ag阳性慢性乙型肝炎孕妇替比夫定治疗前后血清Th1/Th2型细胞因子的水平变化[J].临床肝胆病杂志, 2014, 30 (6) :522-526.

[8] LYNGE NILSSON L, DJURISIC S, HVIID TV. Controlling the immunological crosstalk during conception and pregnancy:HLA-G in reproduction[J]. Front Immunol, 2014, 5:198.

[9] MELLOR AL, MUNN DH. IDO expression by dendritic cells:Tolerance and tryptophan catabolism[J]. Nat Rev Immunol, 2004, 4 (10) :762-774.

[10] FUJIKAWA T, NUMAZAKI K, ASANUMA H, et al. Frequency of human cytomegalovirus-specific T cells during pregnancy determined by intracellular cytokine staining[J]. J Med Virol, 2003, 71 (4) :527-531.

[11] ALANEN A, KAHALA K, VAHLBERG T, et al. Seroprevalence, incidence of prenatal infections and reliability of maternal history of varicella zoster virus, cytomegalovirus, herpes simplex virus and parvovirus B19 infection in South-Western Finland[J].BJOG, 2005, 112:50-56.

[12] GERVAIS A, BACQ Y, BERNUAU J, et al. Decrease in serum ALT and increase in serum HCV RNA during pregnancy in women with chronic hepatitis C[J]. J Hepatol, 2000, 32 (2) :293-299.

[13] SARIN SK, KUMAR M, SHRIVASTAVA S, et al. Influence of chronic HBV infection on pregnancy:A human model of maternofetal virus host interactions[J]. Gastroenterology, 2011, 141 (4) :1522-1525.

[14] KALVATCHEV Z, SLAVOV S, SHTEREVA M, et al. Reactivation of Polyomavirus hominis 1 (BKV) during pregnancy and the risk of mother-to-child transmission[J]. J Clin Virol, 2008, 43 (3) :328-329.

[15] ALMOG Y, KLEIN A, ADLER R, et al. Estrogen suppresses hepatitis B virus expression in male athymic mice transplanted with HBV transfected Hep G-2 cells[J]. Antiviral Res, 1992, 19 (4) :285-293.

[16] NGUYEN G, GARCIA RT, NGUYEN N, et al. Clinical course of hepatitis B virus infection during pregnancy[J]. Aliment Pharmacol Ther, 2009, 29 (7) :755-764.

[17] CHANG CY, AZIZ N, POONGKUNRAN M, et al. Serum alanine aminotransferase and hepatitis B DNA flares in pregnant and postpartum women with chronic hepatitis B[J]. Am J Gastroenterol, 2016, 111 (10) :1410-1415.

[18] LIU J, BI Y, XU C, et al. Kinetic changes of viremia and viral antigens of hepatitis B virus during and after pregnancy[J].Medicine (Baltimore) , 2015, 94 (45) :e2001.

[19] XU C, LIU J, LIU L, et al. Comparison of hepatitis B viral loads and viral antigen levels in child-bearing age women with and without pregnancy[J]. BMC Pregnancy Childbirth, 2018, 18 (1) :292.

[20] LIN HH, CHEN PJ, CHEN DS, et al. Postpartum subsidence of hepatitis B viral replication in HBe Ag-positive carrier mothers[J]. J Med Virol, 1989, 29 (1) :1-6.

[21] LIN HH, WU WY, KAO JH, et al. Hepatitis B post-partum e antigen clearance in hepatitis B carrier mothers:Correlation with viral characteristics[J]. J Gastroenterol Hepatol, 2006, 21 (3) :605-609.

[22] PREDINE J, MERCERON L, BARRIER G, et al. Unbound cortisol in umbilical cord plasma and maternal plasma:A reinvestigation[J]. Am J Obstet Gynecol, 1979, 135 (8) :1104-1108.

[23] BERGMANN TK, BARRACLOUGH KA, LEE KJ, et al. Clinical pharmacokinetics and pharmacodynamics of prednisolone and prednisone in solid organ transplantation[J]. Clin Pharmacokinet, 2012, 51 (11) :711-741.

[24] TAN HH, LUI HF, CHOW WC. Chronic hepatitis B virus (HBV) infection in pregnancy[J]. Hepatol Int, 2008, 2 (3) :370-375.

[25] POTTHOFF A, RIFAI K, WEDEMEYER H, et al. Successful treatment of fulminant hepatitis B during pregnancy[J]. Z Gastroenterol, 2009, 47 (7) :667-670.

[26] CAO YJ, LIU M, CAI HD, et al. Postpartum observation of changes in liver function of pregnant women with hepatitis B virus infection in immune tolerant phase[J/CD]. Chin J Exp Clin Infect Dis:Electronic Edition, 2013, 7 (3) :444-447. (in Chinese) 曹彦君, 刘敏, 蔡晧东, 等.免疫耐受期HBV感染的孕妇产后肝功能变化[J/CD].中华试验和临床感染病杂志:电子版, 2013, 7 (3) :444-447.

[27] YANG YB, LI XM, SHI ZJ, et al. Pregnant woman with fulminant hepatic failure caused by hepatitis B virus infection:A case report[J]. World J Gastroenterol, 2004, 10 (15) :2305-2306.

[28] HAN GR, XU CL, ZHAO W, et al. Management of chronic hepatitis B in pregnancy[J]. World J Gastroenterol, 2012, 18 (33) :4517-4521.

[29] WONG S, CHAN LY, YU V, et al. Hepatitis B carrier and perinatal outcome in singleton pregnancy[J]. Am J Perinatol, 1999, 16:485-488.

[30] TSE KY, HO LF, LAO T. The impact of maternal HBsAg carrier status on pregnancy outcomes:A case-control study[J].J Hepatol, 2005, 43 (5) :771-775.

[31] LAMPERTICO P, AGARWAL K, BERG T, et al. EASL 2017clinical practice guidelines on the management of hepatitis B virus infection[J]. J Hepatol, 2017, 67 (2) :370-398.

[32] LIU Y, WANG M, YAO S, et al. Efficacy and safety of telbivudine in different trimesters of pregnancy with high viremia for interrupting perinatal transmission of hepatitis B virus[J].Hepatol Res, 2016, 46 (3) :e181-e188.

[33] XU WM, CUI YT, WANG L, et al. Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection:A multicentre, randomized, double-blind, placebocontrolled study[J]. J Viral Hepat, 2009, 16 (2) :94-103.

[34] HAN GR, JIANG HX, YUE X, et al. Efficacy and safety of telbivudine treatment:An open-label, prospective study in pregnant women for the prevention of perinatal transmission of hepatitis B virus infection[J]. J Viral Hepat, 2015, 22 (9) :754-762.

[35] ZHANG YQ, YAN ZH, SHI XX, et al. Association between SLC10A1 genetic variations and suspectbility to hepatitis B virus infection by mother-to-child transmission[J]. Chin J Clin Infect Dis, 2016, 9 (2) :168-172, 179. (in Chinese) 张艳琼, 晏泽辉, 石新星, 等. SLCIOAl基因变异与HBV母婴传播易感性的相关性研究[J].中华临床感染病杂志, 2016, 9 (2) :168-172, 179.

[36] TERRAULT NA, LOK AS, MCMAHON BJ, et al. Update on prevention, diagnosis, and treatment and of chronic hepatitis B:AASLD 2018 hepatitis B guidance[J]. Hepatology, 2018, 67 (4) :1560-1599.

[37] Chinese Foundation for hepatitis Prevention and Control; Chinese Society of Infectious Diseases, Chinese Medical Association, Chinese Society of Hepatology, Chinese Medical Association. Management algorithm for interrupting mother-tochild transmission of hepatitis B[J]. J Clin Hepatol, 2017, 33 (7) :1214-1217. (in Chinese) 中国肝炎防治基金会, 中华医学会感染病学分会, 中华医学会肝病学分会.乙型肝炎母婴阻断临床管理流程[J].临床肝胆病杂志, 2017, 33 (7) :1214-1217.

[38] NGUYEN V, TAN PK, GREENUP AJ, et al. Anti-viral therapy for prevention of perinatal HBV transmission:Extending therapy beyond birth dose not proect against post-partum flare[J]. Aliment Pharmacol Ther, 2014, 39 (10) :1225-1234.

[39] YIN YH, DONG ML, SHI M, et al. Effect of the time of withdrawing antiviral therapy on postpartum liver function and mother-to-child[J]. Chin J Infect Chemother, 2018, 18 (3) :263-266. (in Chinese) 尹迎辉, 董明亮, 石梅, 等.慢性乙型肝炎病毒感染孕妇抗病毒停药时间对产后功能及母婴传播的影响[J].中国感染与化疗杂志, 2018, 18 (3) :263-266.

[40] GUO HJ, GAO YF, LIU HY, et al. Impact of cessation of antiviral therapy at delivery on postpartum liver function in mothers with chronic hepatitis B virus infection[J]. Chin J Hepatol, 2019, 27 (2) :112-117.郭辉杰, 高云飞, 刘惠媛, 等.妊娠期抗病毒治疗的慢性乙型肝炎病毒感染孕妇分娩时停药对产后肝功能的影响[J].中华肝脏病杂志, 2019, 27 (2) :112-117.

施引文献

资源附件(0)

访问统计