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妊娠合并慢性乙型肝炎的管理。

Management of chronic hepatitis B in pregnancy.

机构信息

Department of Gynecology and Obstetrics, The Second Affiliated Hospital of the Southeast University, Nanjing 210003, Jiangsu Province, China.

出版信息

World J Gastroenterol. 2012 Sep 7;18(33):4517-21. doi: 10.3748/wjg.v18.i33.4517.

Abstract

Pregnancy associated with chronic hepatitis B (CHB) is a common and important problem with unique challenges. Pregnant women infected with CHB are different from the general population, and their special problems need to be considered: such as the effect of hepatitis B virus (HBV) infection on the mother and fetus, the effect of pregnancy on replication of the HBV, whether mothers should take HBV antiviral therapy during pregnancy, the effect of these treatments on the mother and fetus, how to carry out immunization of neonates, whether it can induce hepatitis activity after delivery and other serious issues. At present, there are about 350 million individuals with HBV infection worldwide, of which 50% were infected during the perinatal or neonatal period, especially in HBV-endemic countries. Currently, the rate of HBV infection in the child-bearing age group is still at a high level, and the infection rate is as high as 8.16%. Effective prevention of mother-to-child transmission is an important means of reducing the global burden of chronic HBV infection. Even after adopting the combined immunization measures, there are still 5%-10% of babies born with HBV infection in hepatitis B e antigen positive pregnant women. As HBV perinatal transmission is the main cause of chronic HBV infection, we must consider how to prevent this transmission to reduce the burden of HBV infection. In this population of chronic HBV infected women of childbearing age, specific detection, intervention and follow-up measures are particularly worthy of attention and discussion.

摘要

妊娠合并慢性乙型肝炎(CHB)是一个常见且重要的问题,具有独特的挑战。感染 CHB 的孕妇与一般人群不同,需要考虑其特殊问题:如乙型肝炎病毒(HBV)感染对母亲和胎儿的影响、妊娠对 HBV 复制的影响、母亲是否应在妊娠期间进行 HBV 抗病毒治疗、这些治疗对母亲和胎儿的影响、如何对新生儿进行免疫接种、产后是否会引发肝炎活动等严重问题。目前,全球约有 3.5 亿人感染 HBV,其中 50%是在围产期或新生儿期感染的,尤其是在 HBV 流行国家。目前,育龄妇女的 HBV 感染率仍处于较高水平,感染率高达 8.16%。有效的母婴传播阻断是降低全球慢性 HBV 感染负担的重要手段。即使采取了联合免疫措施,乙肝 e 抗原阳性孕妇所生婴儿仍有 5%-10%感染 HBV。由于 HBV 围生期传播是慢性 HBV 感染的主要原因,我们必须考虑如何预防这种传播,以减轻 HBV 感染的负担。在这群慢性 HBV 感染的育龄妇女中,特定的检测、干预和随访措施尤其值得关注和讨论。

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