慢性HBV携带孕妇产后自发HBeAg和HBsAg血清清除或转换的病毒学因素分析

Virologic determinants of postpartum spontaneous HBeAg and/ or HBsAg seroclearance or seroconversion in pregnant women who are chronic hepatitis B virus carriers

探讨影响慢性乙型肝炎病毒（HBV）携带孕妇产后自发HBeAg和HBsAg血清清除或转换的相关病毒学特征。方法2002年8月～2004年7月本院诊断的慢性HBV携带孕妇，自2009年10月～2010年3月间随访，检测HBV血清学标志和病毒相关特性。结果在本组419例慢性HBV携带孕妇中，经随访平均6.4年，失访155例。在接受随访的264例（63.0%）中，76例（28.8%）孕期在入组时HBeAg阳性，其中42例（55.3%）随访时发生自发HBeAg转换,这些孕妇孕期HBV DNA、HBeAg 和HBsAg均低于34例未转换组（P值均〈0.01）。在6例血清HBV DNA 〈1×106 IU/ml、17例HBeAg 〈700 S/CO和13例HBsAg 〈1×104 IU/ml孕妇中，随访时自发HBeAg转换分别高达100.0%、100.0%和92.3%。随访时，38例（14.4%）孕妇自发HBsAg清除，HBsAg清除组孕期HB-sAg水平明显低于226例未清除组（P〈0.001）。在25例血清HBsAg 〈100 IU/mL孕妇中，随访时56.0%自发HBsAg清除。结论外周血HBV DNA载量低（〈1×106 IU/ml）、HBeAg水平低（〈700 S/CO）或HBsAg水平低（〈1×104 IU/ml）是自发HBeAg血清转换的有利因素，而当HBsAg 〈100 IU/mL时，更易发生自发HBsAg血清清除。

Objective To study the virologic determinants of spontaneous seroclearance or seroconversion of HBeAg and/or HBsAg in pregnant women who are chronic hepatitis B virus （HBV） carriers. Methods The pregnant women diagnosed as chronic HBV carriers between August,2002 and July,2004 were included and fol-lowed up between October,2009 and March,2010. The HBV serologic markers and HBV DNA were detected. Results A total of 419 individuals were recruited in this study,and the average follow-up period was 6.4 years. Although 155 women lost,a total of 264（63.0%） women were successfully followed up,of whom 76 （28.8%） were HBeAg-positive at presentation. 55.3%（42/76） of HBeAg-positive women were seroconverted to anti-HBe sponta-neously at the follow-up. Compared with 34 women without seroconversion,42 with HBeAg/anti-HBe seroconver-sion had lower levels of serum HBV DNA,HBeAg and HBsAg（all P﹤0.01）. The postpartum HBeAg seroconversion rate in 6 pregnant women with HBV DNA ﹤1×106 IU/ml,17 with HBeAg ﹤700 S/CO,and 13 with HBsAg﹤1×104 IU/ml were 100.0%,100.0% and 92.3%,respectively. The spontaneous HBsAg seroclearance was found in 38 （14.4%） women at the follow-up. The serum HBsAg levels at presentation were significantly lower in women with HBsAg seroclearance than 226 without HBsAg seroclearance （P﹤0.001）. The postpartum HBsAg seroclearance rate in 25 pregnant women with HBsAg ﹤100 IU/ml was as high as 56.0%. Conclusions HBeAg-positive women with serum HBV DNA ﹤1 ×10^6 IU/ml,HBeAg ﹤700 S/CO and/or HB-sAg ﹤1×10^4 IU/ml are more likely to undergo spontaneous HBeAg seroconversion,and those with serum HBsAg ﹤100 IU/ml have a higher chance of spontaneous HBsAg sero-clearance.