摘要
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.
出处
《实用肝脏病杂志》
CAS
2014年第4期376-379,共4页
Journal of Practical Hepatology
基金
南京市第一层次卫生人才项目(编号:2011024)
南京大学医学院附属鼓楼医院青年科研启动基金(编号:QJ2012013)