中国肝脏病杂志（电子版）
中國肝髒病雜誌（電子版）
중국간장병잡지（전자판）
CHINESE JOURNAL OF LIVER DISEASES(ELECTRONIC VERSION)
2015年
2期
49-52
,共4页
付冬%刘敏%易为%马小艳%蔡晧东
付鼕%劉敏%易為%馬小豔%蔡晧東
부동%류민%역위%마소염%채호동
非活动性HBsAg携带者%孕妇%肝炎病毒,乙型%肝病再活动%抗病毒治疗%妊娠结局
非活動性HBsAg攜帶者%孕婦%肝炎病毒,乙型%肝病再活動%抗病毒治療%妊娠結跼
비활동성HBsAg휴대자%잉부%간염병독,을형%간병재활동%항병독치료%임신결국
Inactive HBsAg carriers%Pregnant women%Hepatitis B virus(HBV)%Liver disease activity again%Antiviral therapy%Pregnancy outcome
目的：探讨孕期HBV再活动对妊娠的影响。方法研究对象为2012年1月1日至2012年6月30日在本院妇产科生育的孕妇：孕前2年内有2次以上的检测结果证明符合我国2010年《慢性乙型肝炎防治指南》中非活动性HBsAg携带者的诊断标准[5]；孕期发生HBV再活动，表现为HBV DNA≥4 log10拷贝/ml；孕期至产后42天内出现ALT异常。对患者孕期肝病活动情况、治疗及妊娠情况进行回顾性分析。结果研究对象符合入组及排除条件。23例患者孕期HBV DNA水平最高值平均为（6.2±0.9）log10拷贝/ml；1例患者发生HBV再活动后HBeAg转阳，其余22例均保持HBeAg阴性。ALT最高值平均为（260.9±203.6）U/L，AST最高值平均为（170.4±129.1）U/L。95.7%患者从第1孕期即发现HBV DNA反弹；随着HBV DNA反弹，68.6%的患者在第1孕期即出现ALT异常，但ALT峰值可以发生在怀孕的任何时间，主要发生在第2～3孕期和产后。23例患者中有9例患者（39.1%）ALT＞2倍正常值上限（upper limit of normal，ULN），其中5例在孕期住院治疗，1例在产后住院治疗。9例患者在孕期（16～28周，中位数28周）开始抗病毒治疗，均达到病毒学完全应答和肝功能恢复正常的疗效。23例患者中10例（43.5%）孕期并发糖尿病，3例（13.0%）发生产后出血，1例（4.3%）并发子痫前期。15例（65.2%）剖宫产，8例（34.8%）自然分娩，平均孕期为（39.2±0.9）周，均活产，无早产，无低体重儿。产后随访28周，7例（30.4%）患者自发好转（HBV DNA＜500拷贝/ml， ALT正常）；9例孕期开始抗病毒治疗的患者8例产后继续服药治疗，1例停药；5例患者因产后ALT持续异常，开始抗病毒治疗；2例患者保肝治疗，ALT恢复正常。结论妊娠期间非活动性HBsAg携带者有可能发生HBV再活动。对妊娠期间非活动性HBsAg携带的患者应该监测HBV DNA和肝功能。发生HBV再活动的患者应给予及时治疗，必要时孕期使用抗病毒药物，以防孕期肝病加重。
目的：探討孕期HBV再活動對妊娠的影響。方法研究對象為2012年1月1日至2012年6月30日在本院婦產科生育的孕婦：孕前2年內有2次以上的檢測結果證明符閤我國2010年《慢性乙型肝炎防治指南》中非活動性HBsAg攜帶者的診斷標準[5]；孕期髮生HBV再活動，錶現為HBV DNA≥4 log10拷貝/ml；孕期至產後42天內齣現ALT異常。對患者孕期肝病活動情況、治療及妊娠情況進行迴顧性分析。結果研究對象符閤入組及排除條件。23例患者孕期HBV DNA水平最高值平均為（6.2±0.9）log10拷貝/ml；1例患者髮生HBV再活動後HBeAg轉暘，其餘22例均保持HBeAg陰性。ALT最高值平均為（260.9±203.6）U/L，AST最高值平均為（170.4±129.1）U/L。95.7%患者從第1孕期即髮現HBV DNA反彈；隨著HBV DNA反彈，68.6%的患者在第1孕期即齣現ALT異常，但ALT峰值可以髮生在懷孕的任何時間，主要髮生在第2～3孕期和產後。23例患者中有9例患者（39.1%）ALT＞2倍正常值上限（upper limit of normal，ULN），其中5例在孕期住院治療，1例在產後住院治療。9例患者在孕期（16～28週，中位數28週）開始抗病毒治療，均達到病毒學完全應答和肝功能恢複正常的療效。23例患者中10例（43.5%）孕期併髮糖尿病，3例（13.0%）髮生產後齣血，1例（4.3%）併髮子癇前期。15例（65.2%）剖宮產，8例（34.8%）自然分娩，平均孕期為（39.2±0.9）週，均活產，無早產，無低體重兒。產後隨訪28週，7例（30.4%）患者自髮好轉（HBV DNA＜500拷貝/ml， ALT正常）；9例孕期開始抗病毒治療的患者8例產後繼續服藥治療，1例停藥；5例患者因產後ALT持續異常，開始抗病毒治療；2例患者保肝治療，ALT恢複正常。結論妊娠期間非活動性HBsAg攜帶者有可能髮生HBV再活動。對妊娠期間非活動性HBsAg攜帶的患者應該鑑測HBV DNA和肝功能。髮生HBV再活動的患者應給予及時治療，必要時孕期使用抗病毒藥物，以防孕期肝病加重。
목적：탐토잉기HBV재활동대임신적영향。방법연구대상위2012년1월1일지2012년6월30일재본원부산과생육적잉부：잉전2년내유2차이상적검측결과증명부합아국2010년《만성을형간염방치지남》중비활동성HBsAg휴대자적진단표준[5]；잉기발생HBV재활동，표현위HBV DNA≥4 log10고패/ml；잉기지산후42천내출현ALT이상。대환자잉기간병활동정황、치료급임신정황진행회고성분석。결과연구대상부합입조급배제조건。23례환자잉기HBV DNA수평최고치평균위（6.2±0.9）log10고패/ml；1례환자발생HBV재활동후HBeAg전양，기여22례균보지HBeAg음성。ALT최고치평균위（260.9±203.6）U/L，AST최고치평균위（170.4±129.1）U/L。95.7%환자종제1잉기즉발현HBV DNA반탄；수착HBV DNA반탄，68.6%적환자재제1잉기즉출현ALT이상，단ALT봉치가이발생재부잉적임하시간，주요발생재제2～3잉기화산후。23례환자중유9례환자（39.1%）ALT＞2배정상치상한（upper limit of normal，ULN），기중5례재잉기주원치료，1례재산후주원치료。9례환자재잉기（16～28주，중위수28주）개시항병독치료，균체도병독학완전응답화간공능회복정상적료효。23례환자중10례（43.5%）잉기병발당뇨병，3례（13.0%）발생산후출혈，1례（4.3%）병발자간전기。15례（65.2%）부궁산，8례（34.8%）자연분면，평균잉기위（39.2±0.9）주，균활산，무조산，무저체중인。산후수방28주，7례（30.4%）환자자발호전（HBV DNA＜500고패/ml， ALT정상）；9례잉기개시항병독치료적환자8례산후계속복약치료，1례정약；5례환자인산후ALT지속이상，개시항병독치료；2례환자보간치료，ALT회복정상。결론임신기간비활동성HBsAg휴대자유가능발생HBV재활동。대임신기간비활동성HBsAg휴대적환자응해감측HBV DNA화간공능。발생HBV재활동적환자응급여급시치료，필요시잉기사용항병독약물，이방잉기간병가중。
Objective To explore the influence of HBV remobilization during the period of pregnancy. MethodsThe patients who delivered in the department of gynaecology and obstetrics, Beijing Ditan Hospital from January 1, 2012 to June 30, 2012 were selected. All of them were tested to be HBsAg carriers more than two times within two years before pregnancy according to “chronic hepatitis B prevention and control guideline” of China in 2012. During pregnancy, HBV remobilized which characterized by HBV DNA≥ 4 log10copies/ml. The ALT level was abnormal from the ifrst pregnancy period to postpartum 42 days. The conditions of pregnate patients with liver disease, the treatment and the pregnancy outcomes were retrospectively analyzed respectively.Results Research objects conformed to the divided and excluded conditions. The average value of the highest HBV DNA level was (6.2 ± 0.9) log10 copies/ml. One of the patients’ HBeAg turned to be positive after HBV remobilization, and the other twenty twopatients’ HBeAg remained negative. The maximum value of ALT averaged (260.9 ± 203.6) U/L,and AST averaged (170.4 ± 129.1) U/L . 95.7% of the patients’ HBV DNA rebounded in the first trimester of pregnancy. With the rebounding of HBV DNA, 68.6% of the patients appeared ALT disordered in the ifrst trimester of pregnancy. However, the ALT peak value occured at any time during pregnancy, mainly at the secondary to tertiary period of pregnancy and postpartum. The ALT levels of 9 patients (9/23, 39.1%), 5 of whom were hospitalized for treatment and 1 was in postpartum care, were higher than twice of the upper limit of normal, ULN. Nine patients were given antiviral therapy during pregnancy (16 to 28 weeks, median 28 weeks), and achieved the curative effect of virological response and the liver functions returned to be normal completely. Ten (43.5%) of the twenty three patients had complication with diabetes, three (13.0%) had postpartum hemorrhage and one (4.3%)had preeclampsia. Fifteen patients (65.2%) were treated with caesarean and eight delivered normally and spontaneously, the average pregnancy were (39.2 ± 0.9) weeks, all live births without premature and low-birth-weight infant (LBWI). With twenty-eight weeks postpartum follow-up, seven patients (30.4%) spontaneously improved (HBV DNA< 500 copies/ml,ALT normal); eight of the nine patients who had antiviral treatment continued medical treatment in postpartum and one patient withdrawed the drug; five patients were given antiviral treatment because of the abnormal postpartum ALT and two patients were given supportive liver protection therapy and the ALT backed to normal.ConclusionsThe HBV is likely to be active again in inactive HBsAg carriers during pregnancy. Inactive HBsAg carriers of pregnant patients on pregnancy should be monitored with HBV DNA and liver function. In order to prevent the aggravation of liver disease during pregnancy, timely treatment shall be given to the patients with HBV activity again, antiviral drugs can be used during pregnancy when necessary.
