抗病毒治疗可缩短慢性乙型肝炎病毒感染产妇产后肝炎复发的 ALT 复常时间，并降低 4 年内的肝炎再发率。
Antiviral Therapy for a Postpartum Flare in Women with Chronic HBV Infection Shortens the ALT Recovery Time and Reduces Hepatitis Re-Flare Rates within 4 years.
机构信息
Center of Liver Diseases Division 3, Beijing Ditan Hospital, Capital Medical University, Bejing 100015, China.
Peking University Ditan Teaching Hospital, Beijing 100015, China.
出版信息
Can J Gastroenterol Hepatol. 2022 Jun 20;2022:4753267. doi: 10.1155/2022/4753267. eCollection 2022.
BACKGROUND
Few studies explored whether anti-hepatitis B virus (HBV) therapy should be initiated during postpartum hepatitis flare.
AIM
This study aimed to analyze the effect of anti-HBV therapy on postpartum hepatitis flare and evaluate the prognosis within 4 years postpartum.
METHODS
This retrospective study enrolled hepatitis B surface antigen (HBsAg)-positive and hepatitis B e antigen (HBeAg)-positive pregnant women with HBV DNA ≥ 10 IU/mL. A total of 152 pregnant women were included: 103 in the prophylactic anti-HBV therapy group (PT-G) and 49 in the non-prophylactic anti-HBV therapy group (NPT-G). The women with a postpartum flare were assigned to the anti-HBV therapy group (AT-G) and non-anti-HBV therapy group (NAT-G) to analyze the effect of postpartum anti-HBV therapy on hepatitis flare. Virological and biochemical parameters were assessed.
RESULTS
Taking postpartum 12 weeks as the cutoff point, the ALT recovered time for postpartum flare women is shorter in AT-G ( = 16, 42.1%) or PT-G ( = 23, 34.8%) than in NAT-G ( = 14, 23.0%; = 4.067, =0.044) or NPT-G ( = 4, 11.1%; = 5.579, =0.018). Taking postpartum 26 weeks as the cutoff point, the ALT recovered time is shorter in AT-G ( = 35, 57.3%) or PT-G ( = 44, 66.7%) than in NAT-G ( = 32, 84.2%; = 7.707, =0.006) or NPT-G ( = 16, 44.4%; = 4.749, =0.029). Postpartum flare recovery time was positively correlated with HBV DNA level at delivery [ = 0.223, =0.025, 95%CI (0.022～0.41)]. The hepatitis re-flare rates within postpartum 4 years in AT-G ( = 3, 9.68%) is lower than that in NAT-G ( = 24, 45.4%; = 14.003, ≤ 0.001). The HBeAg, HBsAg, HBV DNA, and ALT level at postpartum 4 years in AT-G were lower than that in NAT-G ( < 0.001).
CONCLUSION
Anti-HBV therapy for postpartum hepatitis flare of women with chronic HBV could shorten the ALT recovery time and reduce hepatitis re-flare rates within 4 years of postpartum.
背景
鲜有研究探讨产后肝炎发作时是否应启动抗乙型肝炎病毒（HBV）治疗。
目的
本研究旨在分析抗 HBV 治疗对产后肝炎发作的影响，并评估产后 4 年内的预后。
方法
本回顾性研究纳入 HBV 表面抗原（HBsAg）阳性和 HBeAg 阳性且 HBV DNA≥10 IU/mL 的妊娠妇女。共纳入 152 例妊娠妇女：103 例预防性抗 HBV 治疗组（PT-G）和 49 例非预防性抗 HBV 治疗组（NPT-G）。将产后出现肝炎发作的妇女分为抗 HBV 治疗组（AT-G）和非抗 HBV 治疗组（NAT-G），以分析产后抗 HBV 治疗对肝炎发作的影响。评估病毒学和生化学参数。
结果
以产后 12 周为截止点，产后肝炎发作妇女的 ALT 恢复时间在 AT-G（ = 16，57.3%）或 PT-G（ = 23，34.8%）中比在 NAT-G（ = 14，23.0%； = 4.067，=0.044）或 NPT-G（ = 4，11.1%； = 5.579，=0.018）中更短。以产后 26 周为截止点，ALT 恢复时间在 AT-G（ = 35，57.3%）或 PT-G（ = 44，66.7%）中比在 NAT-G（ = 32，84.2%； = 7.707，=0.006）或 NPT-G（ = 16，44.4%； = 4.749，=0.029）中更短。产后肝炎发作的恢复时间与分娩时 HBV DNA 水平呈正相关[ = 0.223，=0.025，95%CI（0.022～0.41）]。产后 4 年内，AT-G（ = 3，9.68%）的肝炎再发作率低于 NAT-G（ = 24，45.4%； = 14.003， ≤ 0.001）。产后 4 年时，AT-G 的 HBeAg、HBsAg、HBV DNA 和 ALT 水平均低于 NAT-G（ < 0.001）。
结论
对慢性 HBV 感染女性的产后肝炎发作进行抗 HBV 治疗，可以缩短 ALT 恢复时间，并降低产后 4 年内的肝炎再发作率。
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