Lu Junfeng, Zhang Shibin, Liu Yali, Du Xiaofei, Ren Shan, Zhang Hua, Ma Lina, Chen Yue, Chen Xinyue, Shen Chengli
International Medical Department, Beijing Youan Hospital, Capital Medical, Beijing, China.
Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA.
Liver Int. 2015 Jun;35(6):1692-9. doi: 10.1111/liv.12753. Epub 2015 Jan 21.
BACKGROUND & AIMS: Currently, routine antiviral treatment is not recommended for immune-tolerant subjects with chronic HBV infection. In this study, we assessed the treatment efficacy of combining Peg IFN α-2a with Adefovir (CPIA) in chronic HBV infected pregnant women with normal levels of ALT and high levels of HBV after delivery.
Chronic hepatitis B pregnant women with normal levels of ALT and high levels of HBV DNA were treated with Telbivudine during the third trimester of their pregnancy. After childbirth, based on serological and virological parameters, the patients were either switched to CPIA treatment for 96 weeks or stopped Telbivudine treatment and followed for 48 weeks.
A total of 68 patients were enrolled in this study. Thirty (30/68) of them were switched to CPIA treatment after childbirth, 93.3% (28/30) of them achieved virological response, 56.7% (17/30) achieved HBeAg seroclearance and 26.7% (8/30) cleared HBsAg. The HBV DNA and HBeAg levels before CPIA treatment were negatively associated with HBeAg seroclearance. HBsAg and HBeAg levels in week 12 and week 24 after CPIA treatment were negatively associated with HBsAg seroclearance. Thirty-eight (38/68) patients did not receive antiviral treatment after childbirth, and none of them had HBeAg or HBsAg clearance.
High rates of viral response and clearance were achieved in chronic hepatitis B pregnant woman with normal levels of ALT and high levels of HBV DNA treated by CPIA after childbirth. (231 words).
目前，不建议对慢性HBV感染的免疫耐受者进行常规抗病毒治疗。在本研究中，我们评估了聚乙二醇干扰素α-2a联合阿德福韦（CPIA）对分娩后谷丙转氨酶（ALT）水平正常但乙肝病毒（HBV）水平高的慢性HBV感染孕妇的治疗效果。
对妊娠晚期ALT水平正常且HBV DNA水平高的慢性乙型肝炎孕妇给予替比夫定治疗。分娩后，根据血清学和病毒学参数，将患者改为接受CPIA治疗96周，或停止替比夫定治疗并随访48周。
本研究共纳入68例患者。其中30例（30/68）分娩后改为接受CPIA治疗，其中93.3%（28/30）实现病毒学应答，56.7%（17/30）实现HBeAg血清学清除，26.7%（8/30）清除HBsAg。CPIA治疗前的HBV DNA和HBeAg水平与HBeAg血清学清除呈负相关。CPIA治疗后第12周和第24周的HBsAg和HBeAg水平与HBsAg血清学清除呈负相关。38例（38/68）患者分娩后未接受抗病毒治疗，无一例实现HBeAg或HBsAg清除。
分娩后接受CPIA治疗的ALT水平正常但HBV DNA水平高的慢性乙型肝炎孕妇实现了较高的病毒应答率和清除率。（231字）
