Samadi Kochaksaraei G, Castillo E, Osman M, Simmonds K, Scott A N, Oshiomogho J I, Lee S S, Myers R P, Martin S R, Coffin C S
Calgary Liver Unit, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Medical Disorders in Pregnancy, Division of Internal Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
J Viral Hepat. 2016 Jan;23(1):15-22. doi: 10.1111/jvh.12436. Epub 2015 Jul 20.
Hepatitis B immunoprophylaxis failure is linked to high maternal viraemia. There is limited North American data on hepatitis B outcomes in pregnancy. Pregnant hepatitis B carriers were enrolled January 2011-December 2014 and offered tenofovir in the 3rd trimester if hepatitis B virus (HBV)-DNA was >7-log IU/mL. Outcomes were determined in treated vs untreated patients. In total, 161 women with 169 pregnancies (one twin, 170 infants; median age 32 years), 18% (29/161) HBeAg+ and median HBV-DNA 2.51 log IU/mL (IQR 1.66-3.65; range 0.8-8.1) were studied. 14.3% (23/161) received tenofovir due to high viral load (16/23, median 74 days, IQR 59-110) or due to liver disease (7/23). In 10/16 treated due to high viraemia, with confirmed adherence, follow-up HBV-DNA showed a 5.49 log decline (P = 0.003). In treatment naïve mothers, median alanine aminotransferase (ALT) increased from 17 IU/L (IQR 12-24) to 29 (IQR 18-36) post-partum (P = 1.5e-7). In seven highly viraemic mothers who declined therapy (HBV-DNA >8-log IU/mL); median ALT increased ~3X from baseline (P < 0.01). 26% (44/169) had Caesarean section with no difference in treated vs untreated subjects. No tenofovir-treated mothers had renal dysfunction. Data were available on 167/170 infants; in 50.8% (85/167) who completed immunoprophylaxis, 98.8% (84/85, including 12 exposed to tenofovir in utero) were HBV immune. One infant born to an HBeAg+ mother with HBV-DNA >8-log IU/mL failed immunoprophylaxis. In this prospective Canadian cohort study, most untreated mothers experienced mild HBV flares. Tenofovir in pregnancy is well tolerated and reduces viral load prior to parturition.
乙型肝炎免疫预防失败与孕妇高病毒血症有关。北美关于妊娠期间乙型肝炎结局的数据有限。2011年1月至2014年12月纳入了妊娠乙型肝炎携带者，若乙肝病毒（HBV）-DNA>7 log IU/mL，则在孕晚期给予替诺福韦。对接受治疗和未接受治疗的患者的结局进行了测定。总共研究了161名女性的169次妊娠（1例双胞胎，共170名婴儿；中位年龄32岁），其中18%（29/161）为HBeAg阳性，HBV-DNA中位数为2.51 log IU/mL（四分位间距1.66 - 3.65；范围0.8 - 8.1）。14.3%（23/161）因病毒载量高（16/23，中位数74天，四分位间距59 - 110）或因肝病（7/23）接受了替诺福韦治疗。在因高病毒血症接受治疗的16例患者中，经确认依从性良好，随访时HBV-DNA下降了5.49 log（P = 0.003）。在未接受过治疗的母亲中，产后丙氨酸转氨酶（ALT）中位数从17 IU/L（四分位间距12 - 24）升至29（四分位间距18 - 36）（P = 1.5×10⁻⁷）。在7例拒绝治疗的高病毒血症母亲中（HBV-DNA>8 log IU/mL），ALT中位数较基线升高约3倍（P < 0.01）。26%（44/169）进行了剖宫产，治疗组和未治疗组之间无差异。接受替诺福韦治疗的母亲均未出现肾功能障碍。170名婴儿中有167名有相关数据；在完成免疫预防的50.8%（85/167）婴儿中，98.8%（84/85，包括12名宫内接触替诺福韦的婴儿）对HBV免疫。1名HBeAg阳性、HBV-DNA>8 log IU/mL母亲所生的婴儿免疫预防失败。在这项前瞻性加拿大队列研究中，大多数未治疗的母亲经历了轻度HBV病情波动。孕期使用替诺福韦耐受性良好，可在分娩前降低病毒载量。
