Wang Chun-Rui, Zhong Guo-Chao, Chen Zhi-Wei, Hu Peng
Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, Institute for Viral Hepatitis, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Med (Lausanne). 2021 Nov 2;8:746759. doi: 10.3389/fmed.2021.746759. eCollection 2021.
Current guidelines recommend that pregnancies with mother-to-child transmission (MTCT) prevention can cease antiviral treatment after delivery. We aimed to develop a nomogram for predicting non-rebound in HBV-infected pregnant women with MTCT prevention after post-partum nucleos(t)ide analogs (NAs) withdrawal based on parameters before treatment cessation. Pregnant women receiving antiviral therapy for MTCT prevention and who withdrew from taking NAs after delivery were included in this study. We used the least absolute shrinkage and selection operator (LASSO) logistics and a two-way stepwise regression to select prognostic factors for the risk model, and the concordance index (C-index) was used to assess its discrimination. Internal validation was performed through bootstrapping. Of 92 included patients, 16 and 76 experienced non-rebound and virologic rebound within 48 weeks of post-partum NAs cessation, respectively. Platelet to lymphocyte ratio (PLR) at 34 ± 2 weeks of gestation, a reduction in hepatitis B surface antigen (HBsAg) from baseline to 34 ± 2 weeks of gestation, and hepatitis B virus (HBV) DNA declining from baseline to the end of treatment (EOT) were entered into the final risk model. Its C-index was 0.91 (95% CI, 0.82-0.99), and it reached as high as 0.88 after bootstrapping validation. The decision curve and decision tree were further developed to facilitate the application of this model. We developed a nomogram for predicting non-rebound in pregnant women with MTCT prevention after the withdrawal of antiviral agents, which facilitates physicians in making appropriate treatment recommendations.
当前指南建议,对于采取母婴传播(MTCT)预防措施的妊娠,分娩后可停止抗病毒治疗。我们旨在基于停止治疗前的参数,开发一种列线图,用于预测产后核苷(酸)类似物(NAs)停药后预防MTCT的HBV感染孕妇不出现病毒反弹的情况。本研究纳入了接受抗病毒治疗以预防MTCT且产后停用NAs的孕妇。我们使用最小绝对收缩和选择算子(LASSO)逻辑回归和双向逐步回归来选择风险模型的预后因素,并使用一致性指数(C指数)评估其区分度。通过自抽样法进行内部验证。在纳入的92例患者中,分别有16例和76例在产后停用NAs的48周内未出现病毒反弹和病毒学反弹。妊娠34±2周时的血小板与淋巴细胞比值(PLR)、从基线到妊娠34±2周时乙肝表面抗原(HBsAg)的下降情况以及从基线到治疗结束(EOT)时乙肝病毒(HBV)DNA的下降情况被纳入最终风险模型。其C指数为0.91(95%CI,0.82 - 0.99),自抽样法验证后高达0.88。进一步绘制了决策曲线和决策树以促进该模型的应用。我们开发了一种列线图,用于预测抗病毒药物停用后预防MTCT的孕妇不出现病毒反弹的情况,这有助于医生做出适当的治疗建议。