中华实验和临床感染病杂志（电子版）
中華實驗和臨床感染病雜誌（電子版）
중화실험화림상감염병잡지（전자판）
CHINESE JOURNAL OF EXPERIMENTAL AND CLINICAL INFECTIOUS DISEASES(ELECTRONIC VERSION)
2013年
3期
444-447
,共4页
曹彦君%易为%刘敏%蔡晧东
曹彥君%易為%劉敏%蔡晧東
조언군%역위%류민%채호동
肝炎,乙型,慢性%免疫耐受%妊娠%产后%肝功能
肝炎,乙型,慢性%免疫耐受%妊娠%產後%肝功能
간염,을형,만성%면역내수%임신%산후%간공능
Chronic hepatitis B%Immune tolerance%Pregnancy%Postpartum%Liver function
目的观察免疫耐受期HBV感染的孕妇产后肝功能的变化。方法通过医院信息系统（HIS）对在本院妇产科产检、生育并完成产后随访的免疫耐受期HBV感染妊娠妇女共378例的临床资料进行回顾性研究，观察其产后肝功能异常的发生率及可能的影响因素。结果本研究中免疫耐受期HBeAg阳性，且HBV DNA载量≥6 log10拷贝/ml的妊娠妇女产后ALT升高的发生率为32.6%（47/144），一般发生在产后42～60 d。19.1%（9/47）患者肝病较严重，需住院治疗。48.9%（23/47）患者需要接受抗病毒治疗，自发性HBeAg血清学转换仅为10.6%（5/47）。产后ALT与孕期HBV复制水平及其波动均无显著相关；但与孕期患者的平均ALT和AST水平有关，ALT和AST水平较高的患者产后容易发生肝功能异常，产后肝功能异常的发生时间多在产后2个月内，其机制与HBV的免疫清除有关。结论免疫耐受期的HBV感染女性孕期肝功能的监测十分重要，应加强对孕期ALT有较大波动或有升高趋势的女性产后肝功能和HBV病毒学的监测和随访，必要时给予抗病毒治疗，预防肝病进展。
目的觀察免疫耐受期HBV感染的孕婦產後肝功能的變化。方法通過醫院信息繫統（HIS）對在本院婦產科產檢、生育併完成產後隨訪的免疫耐受期HBV感染妊娠婦女共378例的臨床資料進行迴顧性研究，觀察其產後肝功能異常的髮生率及可能的影響因素。結果本研究中免疫耐受期HBeAg暘性，且HBV DNA載量≥6 log10拷貝/ml的妊娠婦女產後ALT升高的髮生率為32.6%（47/144），一般髮生在產後42～60 d。19.1%（9/47）患者肝病較嚴重，需住院治療。48.9%（23/47）患者需要接受抗病毒治療，自髮性HBeAg血清學轉換僅為10.6%（5/47）。產後ALT與孕期HBV複製水平及其波動均無顯著相關；但與孕期患者的平均ALT和AST水平有關，ALT和AST水平較高的患者產後容易髮生肝功能異常，產後肝功能異常的髮生時間多在產後2箇月內，其機製與HBV的免疫清除有關。結論免疫耐受期的HBV感染女性孕期肝功能的鑑測十分重要，應加彊對孕期ALT有較大波動或有升高趨勢的女性產後肝功能和HBV病毒學的鑑測和隨訪，必要時給予抗病毒治療，預防肝病進展。
목적관찰면역내수기HBV감염적잉부산후간공능적변화。방법통과의원신식계통（HIS）대재본원부산과산검、생육병완성산후수방적면역내수기HBV감염임신부녀공378례적림상자료진행회고성연구，관찰기산후간공능이상적발생솔급가능적영향인소。결과본연구중면역내수기HBeAg양성，차HBV DNA재량≥6 log10고패/ml적임신부녀산후ALT승고적발생솔위32.6%（47/144），일반발생재산후42～60 d。19.1%（9/47）환자간병교엄중，수주원치료。48.9%（23/47）환자수요접수항병독치료，자발성HBeAg혈청학전환부위10.6%（5/47）。산후ALT여잉기HBV복제수평급기파동균무현저상관；단여잉기환자적평균ALT화AST수평유관，ALT화AST수평교고적환자산후용역발생간공능이상，산후간공능이상적발생시간다재산후2개월내，기궤제여HBV적면역청제유관。결론면역내수기적HBV감염녀성잉기간공능적감측십분중요，응가강대잉기ALT유교대파동혹유승고추세적녀성산후간공능화HBV병독학적감측화수방，필요시급여항병독치료，예방간병진전。
Objective To observe the postpartum changes of liver function of pregnant women with hepatitis B virus infection in immune tolerant phase. Methods Total of 378 pregnant women with hepatitis B virus infection in immune tolerant phase were collected, who completed antenatal examination in obstetrics and gynecology, delivery and postpartum follow-up in our hospital through the hospital information system (HIS). The postpartum incidence of abnormal liver function and the possible inlfuencing factors were studied. Results The postpartum incidence of abnormal ALT of pregnant women was 32.6%(47/144), who had positive HBeAg and HBV DNA level of ≥1 × 106 copies/ml, which generally occurs in postpartum 42-60 days. About 19.1%(9/47) patients need to be hospitalized for treatment for severe liver diseases. And 48.9%(23/47) patients need to receive antiviral treatment. These patients with spontaneous HBeAg seroconversion only accounted for 10.6%(5/47). Postpartum ALT value was associated with the average levels of ALT and AST in pregnancy, which has nothing to do with HBV replication levels and volatility. Postpartum liver function with high levels of ALT and AST during pregnancy was prone to be abnormal. The abnormal liver function often occurs within 2 months after delivery. The abnormal liver function was related to the immune clearance of HBV. Conclusions Liver function monitoring during pregnancy is important for women with HBV infection in immune tolerance. It is also important to monitor the postpartum liver function and HBV infection for women with elevating and fluctuating ALT. The antiviral treatment should be applied when necessary, in order to avoid the progression of liver diseases.
