Departments of Infectious Disease.
Rheumatology and Immunology.
J Clin Gastroenterol. 2018 Nov/Dec;52(10):902-907. doi: 10.1097/MCG.0000000000000877.
A series of changes in the immune system occur during pregnancy and puerperium. Currently, we aim to characterize both the natural changes in liver inflammation and its association with hepatitis B viremia during this special period.
Chronic hepatitis B (CHB) gravidas were recruited and followed up to 52 weeks postpartum. Virological and biochemical parameters were assessed throughout the period.
A total of 1097 CHB mothers had finished the entire follow-up including 451 accepting telbivudine, 178 accepting tenofovir, and 468 without antiviral therapy. Among the mothers, 11.94% went through hepatic flare in the first trimester and the rate decreased to 2.1% at the time of delivery. Nevertheless, a much higher frequency (19.78%) was observed in the early postpartum. Interestingly, alanine aminotransferase level decreased along with the development of pregnancy and then suddenly increased in the first month of puerperium. In addition, a downward trend was observed on the titer of HBsAg and HBeAg after delivery. Of note, an obvious higher frequency of alanine aminotransferase flare was revealed in mothers with high viremia (>6 log10 IU/mL). With multivariate analysis, only hepatitis B virus titer at baseline was strongly associated with hepatic flare during early postpartum (95% confidence interval, 1.012-3.049, P=0.045). The predictive rates of hepatic flare at baseline viral load of 6, 7, and 8 log10 IU/mL were 16.67%, 28.30%, and 30.60%, respectively.
CHB gravidas with high viremia should be monitored closely during entire pregnancy, and extended antiviral therapy is recommend to those mothers with baseline viremia >7 log10 IU/mL.
怀孕期间和产褥期免疫系统会发生一系列变化。目前，我们旨在描述这段特殊时期肝脏炎症的自然变化及其与乙型肝炎病毒血症的关系。
招募慢性乙型肝炎（CHB）孕妇并随访至产后 52 周。整个期间评估病毒学和生化参数。
共有 1097 名 CHB 母亲完成了整个随访，其中 451 名接受替比夫定治疗，178 名接受替诺福韦治疗，468 名未接受抗病毒治疗。在这些母亲中，11.94%在孕早期出现肝酶升高，分娩时这一比例降至 2.1%。然而，在产后早期观察到更高的频率（19.78%）。有趣的是，丙氨酸氨基转移酶水平随着妊娠的发展而降低，然后在产褥期的第一个月突然升高。此外，分娩后 HBsAg 和 HBeAg 的滴度呈下降趋势。值得注意的是，高病毒载量（>6 log10 IU/mL）的母亲中明显观察到更高的丙氨酸氨基转移酶升高频率。多变量分析显示，只有基线乙型肝炎病毒载量与产后早期肝酶升高强烈相关（95%置信区间，1.012-3.049，P=0.045）。基线病毒载量为 6、7 和 8 log10 IU/mL 时肝酶升高的预测率分别为 16.67%、28.30%和 30.60%。
高病毒载量的 CHB 孕妇在整个孕期应密切监测，对于基线病毒载量>7 log10 IU/mL 的母亲，建议延长抗病毒治疗。
