慢性HBV感染孕妇产后肝炎活动与治疗管理

陈婧; 丁洋

doi:10.12449/JCH241106

慢性HBV感染孕妇产后肝炎活动与治疗管理

DOI: 10.12449/JCH241106

陈婧,
丁洋^, ,

中国医科大学附属盛京医院感染科，沈阳 110022

基金项目:

辽宁省科技厅应用基础研究计划项目 (2022JH2/101500009)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：陈婧负责查阅文献，整理初稿和撰写文章；丁洋负责拟定文章思路，撰写文章并最后定稿。

详细信息

通信作者:
丁洋， yding0903@sina.com （ORCID： 0000-0002-7066-2865）

计量
- 文章访问数: 120
- HTML全文浏览量: 1034
- PDF下载量: 41
- 被引次数: 0
出版历程
- 收稿日期: 2024-09-01
- 录用日期: 2024-09-20
- 出版日期: 2024-11-25

Hepatitis flare and treatment in postpartum women with chronic hepatitis B virus infection

Jing CHEN,
Yang DING^{,
,}

Department of Infectious Diseases，Shengjing Hospital of China Medical University，Shenyang 110022，China

Research funding:

Applied Basic Research Program of Liaoning Science and Technology Department (2022JH2/101500009)

More Information

Corresponding author: DING Yang， yding0903@sina.com （ORCID： 0000-0002-7066-2865）

摘要

摘要: 慢性HBV感染孕妇产后由于免疫功能和激素水平变化，可出现肝炎活动。加强慢性HBV感染孕妇产后肝功能、HBV血清标志物和HBV DNA的监测与优化抗病毒治疗策略，对于确保产妇延缓疾病进展和母婴的安全性至关重要。本文将针对慢性HBV感染孕妇产后肝炎活动的临床特点、发病机制和预测因素及治疗策略进行阐述，帮助临床医生更好地监测慢性HBV感染孕妇产后肝炎活动及治疗管理。
- 乙型肝炎病毒 /
- 孕妇 /
- 治疗学
Abstract: Hepatitis flare can happen in postpartum women with chronic hepatitis B virus （HBV） infection due to the changes in immune function and hormone levels. In order to delay disease progression in parturients and ensure the safety of mothers and infants， it is crucial to strengthen the monitoring of liver function， serum HBV markers， and HBV DNA in postpartum women with chronic HBV infection and optimize the strategies for antiviral therapy. This article elaborates on the clinical features， pathogenesis， predictive factors， and treatment strategies for hepatitis flare in postpartum women with chronic HBV infection， in order to help clinicians with the monitoring and treatment of hepatitis flare in postpartum women with chronic HBV infection.
- Hepatitis B Virus /
- Pregnant Women /
- Therapeutics

HTML全文

参考文献(37)

[1]	Chinese Society of Hepatology, Chinese Medical Association; Chinese Society of Infectious Diseases, Chinese Medical Association. uidelines for the prevention and treatment of chronic hepatitis B(version 2022)[J]. Infect Dis Info, 2023, 36( 1): 1- 17. DOI: 10.3969/j.issn.1007-8134.2023.01.01. 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(2022年版)[J]. 传染病信息, 2023, 36( 1): 1- 17. DOI: 10.3969/j.issn.1007-8134.2023.01.01.1
[2]	CUI FQ, WOODRING J, CHAN PL, et al. Considerations of antiviral treatment to interrupt mother-to-child transmission of hepatitis B virus in China[J]. Int J Epidemiol, 2018, 47( 5): 1529- 1537. DOI: 10.1093/ije/dyy077.
[3]	Chinese Society of Hepatology, Chinese Medical Association. Consensus on the management of hepatitis B virus infection in women of childbearing age[J]. J Clin Hepatol, 2018, 34( 6): 1176- 1180. DOI: 10.3969/j.issn.1001-5256.2018.06.008. 中华医学会肝病学分会. 感染乙型肝炎病毒的育龄女性临床管理共识[J]. 临床肝胆病杂志, 2018, 34( 6): 1176- 1180. DOI: 10.3969/j.issn.1001-5256.2018.06.008.
[4]	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-to-child transmission of hepatitis B virus(2021)[J]. J Clin Hepatol, 2021, 37( 3): 527- 531. DOI: 10.3969/j.issn.1001-5256.2021.03.007. 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. 阻断乙型肝炎病毒母婴传播临床管理流程(2021年)[J]. 临床肝胆病杂志, 2021, 37( 3): 527- 531. DOI: 10.3969/j.issn.1001-5256.2021.03.007.
[5]	HAN GR, CAO MK, ZHAO W, et al. A prospective and open-label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus infection[J]. J Hepatol, 2011, 55( 6): 1215- 1221. DOI: 10.1016/j.jhep.2011.02.032.
[6]	GILES M, VISVANATHAN K, LEWIN S, et al. Clinical and virological predictors of hepatic flares in pregnant women with chronic hepatitis B[J]. Gut, 2015, 64( 11): 1810- 1815. DOI: 10.1136/gutjnl-2014-308211.
[7]	PAN CQ, DUAN ZP, DAI EH, et al. Tenofovir to prevent hepatitis B transmission in mothers with high viral load[J]. N Engl J Med, 2016, 374( 24): 2324- 2334. DOI: 10.1056/NEJMoa1508660.
[8]	LIU JF, WANG J, JIN DF, et al. Hepatic flare after telbivudine withdrawal and efficacy of postpartum antiviral therapy for pregnancies with chronic hepatitis B virus[J]. J Gastroenterol Hepatol, 2017, 32( 1): 177- 183. DOI: 10.1111/jgh.13436.
[9]	ZHAO MY, ZOU HB, CHEN Y, et al. Characteristics and mechanism of virological and liver function changes in pregnant women with chronic hepatitis B virus infection during pregnancy and after delivery[J]. J Clin Hepatol, 2019, 35( 6): 1353- 1357. DOI: 10.3969/j.issn.1001-5256.2019.06.038. 赵梦鱼, 邹怀宾, 陈煜, 等. 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[J]. 临床肝胆病杂志, 2019, 35( 6): 1353- 1357. DOI: 10.3969/j.issn.1001-5256.2019.06.038.
[10]	BORG MJ TER, LEEMANS WF, de MAN RA, et al. Exacerbation of chronic hepatitis B infection after delivery[J]. J Viral Hepat, 2008, 15( 1): 37- 41. DOI: 10.1111/j.1365-2893.2007.00894.x.
[11]	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. DOI: 10.1111/j.1440-1746.2006.04198.x.
[12]	ZENG Z, ZHOU MF, LIN YJ, et al. A real-world study on the features of postpartum hepatitis flares in pregnant women with chronic HBV infection[J]. Chin J Hepatol, 2024, 32( 2): 113- 118. DOI: 10.3760/cma.j.cn501113-20231122-00216. 曾湛, 周明芳, 林妍洁, 等. 慢性HBV感染孕妇分娩后肝炎发作特点的真实世界研究[J]. 中华肝脏病杂志, 2024, 32( 2): 113- 118. DOI: 10.3760/cma.j.cn501113-20231122-00216.
[13]	WANG XX, SONG AX, LIN X, et al. Clinical characteristics of hepatitis flares during pregnancy and postpartum in Chinese chronic hepatitis B virus carriers-a prospective cohort study of 417 cases[J]. Front Immunol, 2022, 13: 1031291. DOI: 10.3389/fimmu.2022.1031291.
[14]	ZHANG L, JIANG TT, YANG Y, et al. Postpartum hepatitis and host immunity in pregnant women with chronic HBV infection[J]. Front Immunol, 2023, 13: 1112234. DOI: 10.3389/fimmu.2022.1112234.
[15]	SONG AX, LIU YS, CAO ZH, et al. Clinical features and T cell immune characteristics of postpartum hepatitis flare in pregnant women with HBeAg-positive chronic HBV infection[J]. Front Immunol, 2022, 13: 881321. DOI: 10.3389/fimmu.2022.881321.
[16]	HUANG MT, GAO YF, YIN XR, et al. Characterization of T cell immunity in chronic hepatitis B virus-infected mothers with postpartum alanine transaminase flare[J]. BMC Infect Dis, 2021, 21( 1): 922. DOI: 10.1186/s12879-021-06634-2.
[17]	NGUYEN V, TAN PK, GREENUP AJ, et al. Anti-viral therapy for prevention of perinatal HBV transmission: Extending therapy beyond birth does not protect against post-partum flare[J]. Aliment Pharmacol Ther, 2014, 39( 10): 1225- 1234. DOI: 10.1111/apt.12726.
[18]	KIM HY, CHOI JY, PARK CH, et al. Outcome after discontinuing antiviral agents during pregnancy in women infected with hepatitis B virus[J]. J Clin Virol, 2013, 56( 4): 299- 305. DOI: 10.1016/j.jcv.2012.11.019.
[19]	QUAN M, LIU XM, LIU C, et al. Antiviral therapy for prevention of perinatal hepatitis B virus transmission reduces the incidence of postpartum hepatitis flare[J]. Biomed Res Int, 2022, 2022: 7046955. DOI: 10.1155/2022/7046955.
[20]	SAMADI KOCHAKSARAEI G, SHAHEEN AA, SEOW CH, et al. Tenofovir disoproxil fumarate therapy to prevent hepatitis B virus vertical transmission-a review of maternal and infant outcomes[J]. Liver Int, 2022, 42( 8): 1712- 1730. DOI: 10.1111/liv.15249.
[21]	QUAN M, LIU C, LI W, et al. Antiviral therapy for a postpartum flare in women with chronic HBV infection shortens the ALT recovery time and reduces hepatitis re-flare rates within 4 years[J]. Can J Gastroenterol Hepatol, 2022, 2022: 4753267. DOI: 10.1155/2022/4753267.
[22]	YI W, PAN CQ, LI MH, et al. The characteristics and predictors of postpartum hepatitis flares in women with chronic hepatitis B[J]. Am J Gastroenterol, 2018, 113( 5): 686- 693. DOI: 10.1038/s41395-018-0010-2.
[23]	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. DOI: 10.1038/ajg.2016.296.
[24]	LI L, XU MM, ZOU HB, et al. Meta-analysis of the risk for abnormal liver function in pregnancy with high HBV DNA after antiviral therapy withdrawal[J]. Altern Ther Health Med, 2023, 29( 1): 280- 288.
[25]	ZENG QL, XU GH, WANG B, et al. Prophylactic antiviral therapy for the prevention of mother-to-child transmission of hepatitis B virus can be stopped at delivery[J]. J Viral Hepat, 2018, 25( 5): 612- 613. DOI: 10.1111/jvh.12848.
[26]	XIAO LX, CHEN YR, HUANG P, et al. The safety of antiviral therapy and drug withdrawal for the prevention of mother-to-child transmission of HBV during pregnancy[J]. J Med Virol, 2020, 92( 12): 3381- 3389. DOI: 10.1002/jmv.26011.
[27]	LI MH, SUN FF, BI XY, et al. Effects of antiviral therapy and drug withdrawal on postpartum hepatitis in pregnant women with chronic HBV infection[J]. Hepatol Int, 2023, 17( 1): 42- 51. DOI: 10.1007/s12072-022-10412-w.
[28]	CHEN Y, MAK LY, TANG MHY, et al. Immediate postpartum cessation of tenofovir did not increase risk of virological or clinical relapse in highly viremic pregnant mothers with chronic hepatitis B infection[J]. JHEP Rep, 2024, 6( 5): 101050. DOI: 10.1016/j.jhepr.2024.101050.
[29]	SAMADI KOCHAKSARAEI G, CASTILLO E, SADLER MD, et al. Real-world clinical and virological outcomes in a retrospective multiethnic cohort study of 341 untreated and tenofovir disoproxil fumarate-treated chronic hepatitis B pregnant patients in North America[J]. Aliment Pharmacol Ther, 2020, 52( 11-12): 1707- 1716. DOI: 10.1111/apt.16123.
[30]	LIU RY, YANG L, JIANG TT, et al. Hepatitis B core-related antigen serum levels may be a predictor of acute flare of chronic hepatitis B among pregnant women in the immune-tolerant phase of chronic HBV infection after short-course antiviral therapy[J]. Virulence, 2023, 14( 1): 2186335. DOI: 10.1080/21505594.2023.2186335.
[31]	LI L, ZOU HB, XU MM, et al. Risk factors related to postpartum hepatic inflammation in pregnant women with chronic hepatitis B[J]. J Int Med Res, 2020, 48( 11): 300060520966439. DOI: 10.1177/0300060520966439.
[32]	Infectious Diseases Physicians Branch, Chinese Medical Doctor Association; Chinese Society of Infectious Diseases, Chinese Medical Association. Chinese practice guideline for the prevention and treatment of mother-to-child transmission of hepatitis B virus(version 2024)[J]. J Clin Hepatol, 2024, 40( 8): 1557- 1566. DOI: 10.12449/JCH240809. 中国医师协会感染科医师分会, 中华医学会感染病学分会. 中国乙型肝炎病毒母婴传播防治指南(2024年版)[J]. 临床肝胆病杂志, 2024, 40( 8): 1557- 1566. DOI: 10.12449/JCH240809.
[33]	TRAN TT, AHN J, REAU NS. ACG clinical guideline: Liver disease and pregnancy[J]. Am J Gastroenterol, 2016, 111( 2): 176- 194;quiz196. DOI: 10.1038/ajg.2015.430.
[34]	FENG YL, YAO NJ, SHI L, et al. Efficacy and safety of long-term postpartum antiviral therapy in hepatitis B virus-infected mothers receiving prophylactic tenofovir disoproxil fumarate treatment[J]. Eur J Gastroenterol Hepatol, 2023, 35( 2): 212- 218. DOI: 10.1097/MEG.0000000000002476.
[35]	CHEN XY, WANG XX. Management of liver dysfunction during pregancy and postpartum in pregnant women who are chronic carriers of hepatitis B virus[J]. Chin J Hepatol, 2019, 27( 2): 88- 91. DOI: 10.3760/cma.j.issn.1007-3418.2019.02.003. 陈新月, 王晓晓. 慢性乙型肝炎病毒携带孕妇妊娠及产后肝功能异常及其管理[J]. 中华肝脏病杂志, 2019, 27( 2): 88- 91. DOI: 10.3760/cma.j.issn.1007-3418.2019.02.003.
[36]	LU JF, ZHANG SB, LIU YL, et al. Effect of Peg-interferon α-2a combined with Adefovir in HBV postpartum women with normal levels of ALT and high levels of HBV DNA[J]. Liver Int, 2015, 35( 6): 1692- 1699. DOI: 10.1111/liv.12753.
[37]	ZHONG WT, YAN LZ, ZHU YG, et al. A high functional cure rate was induced by pegylated interferon alpha-2b treatment in postpartum hepatitis B e antigen-negative women with chronic hepatitis B virus infection: An exploratory study[J]. Front Cell Infect Microbiol, 2024, 14: 1426960. DOI: 10.3389/fcimb.2024.1426960.