OuYang Shi, Geng Yawen, Qiu Gongqin, Deng Yueying, Deng Haitao, Pan Calvin Q
Department of Infectious Diseases, Key Laboratory of Biological Targeting Diagnosis, Therapy, and Rehabilitation of Guangdong Higher Education Institutes, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, P. R. China.
School of Public Health, North China University of Science and Technology, Tangshan, Hebie, P. R. China.
Gastroenterol Rep (Oxf). 2024 Oct 22;12:goae091. doi: 10.1093/gastro/goae091. eCollection 2024.
Postpartum elevation of alanine aminotransferase (ALT) in mothers with chronic hepatitis B (CHB) presents a significant clinical challenge. However, the existing literature demonstrates inconsistencies regarding its incidence and predictors in mothers infected with the hepatitis B virus (HBV). Recent advancements in antiviral prophylaxis against mother-to-child transmission of HBV and postpartum cessation of antiviral therapy further complicate this issue. Our literature review, spanning PubMed, and two Chinese-language databases (CNKI and Wanfang) from 1 January 2000 to 31 December 2023 aimed to consolidate and analyse available data on the frequency and severity of postpartum ALT flares, identify risk factors, and propose a management algorithm. Data from 23 eligible studies involving 8,077 pregnant women revealed an overall incidence of postpartum ALT elevation: 25.7% for mild cases, 4.4% for moderate cases, and 1.7% for severe cases. In the subgroup of mothers who were HBeAg-positive and on antiviral prophylaxis for preventing mother-to-child transmission, postpartum intermediate and severe ALT elevations were reported with pooled rates of 5.9% and 0.8%, respectively. Importantly, none resulted in mortality or necessitated liver transplantation. Identified risk factors for postpartum ALT flares in mothers with CHB included HBV DNA levels, ALT levels during pregnancy, postpartum cessation of antiviral treatment, and HBeAg status. By leveraging this evidence and recent data on predictors of intermediate or severe postpartum ALT flares, we propose a risk-stratified algorithm for managing postpartum ALT elevation and selecting therapy in mothers with CHB, tailoring different approaches for treatment-naive vs treatment-experienced populations. These recommendations aim to provide guidance for clinical decision-making and enhance patient outcomes.
慢性乙型肝炎（CHB）母亲产后丙氨酸氨基转移酶（ALT）升高是一个重大的临床挑战。然而，现有文献在感染乙型肝炎病毒（HBV）母亲中其发生率和预测因素方面存在不一致。抗HBV母婴传播的抗病毒预防措施的最新进展以及产后抗病毒治疗的停止使这个问题更加复杂。我们对2000年1月1日至2023年12月31日期间的PubMed以及两个中文数据库（中国知网和万方）进行文献综述，旨在汇总和分析产后ALT升高的频率和严重程度的现有数据，识别风险因素，并提出管理算法。来自23项涉及8077名孕妇的合格研究的数据显示，产后ALT升高的总体发生率：轻度病例为25.7%，中度病例为4.4%，重度病例为1.7%。在HBeAg阳性且接受预防母婴传播抗病毒治疗的母亲亚组中，报告产后中度和重度ALT升高的合并率分别为5.9%和0.8%。重要的是，无一例导致死亡或需要肝移植。CHB母亲产后ALT升高的已识别风险因素包括HBV DNA水平、孕期ALT水平、产后抗病毒治疗的停止以及HBeAg状态。通过利用这些证据以及近期关于中度或重度产后ALT升高预测因素的数据，我们提出了一种风险分层算法，用于管理CHB母亲产后ALT升高并选择治疗方法，为初治人群与有治疗经验的人群量身定制不同的治疗方法。这些建议旨在为临床决策提供指导并改善患者结局。
