低复制期慢性HBV感染孕产妇HBV再激活临床分析

HBV reactivation of pregnant and lying-in women with chronic HBV infection during low replication time

目的探讨低复制期慢性HBV感染孕产妇HBV再激活的临床特点。方法对2014年7月至2015年7月于首都医科大学附属北京地坛医院由专一医师孕检处于低复制期慢性HBV感染孕产妇的HBV再激活指标(HBeAg、HBV DNA、ALT等)进行前瞻性分析。结果本研究纳入的520例HBs Ag阳性妇女中处于低复制期慢性HBV感染的孕产妇170例,占32.6%。对其中资料完整的151例进行分析后发现,HBV再激活率为26.50%(40/51),其中早孕节点[(12±1周)]激活8例(累积激活率5.30%),中孕节点[(24±1周)]激活8例(累积激活率10.60%),晚孕节点[(36±1周)]激活10例(累积激活率17.20%),产后42天节点激活14例(累积激活率26.50%),差异有统计学意义(χ~2=29.821,P<0.001)。结论随着时间推移,慢性低复制期HBV感染孕产妇围生期HBV累积再激活率显著增加,应加强HBV再激活相关指标的监测,确保母婴安全及阻断成功。

Objective To investigate the clinical characteristics of HBV reactivation in pregnant and lying-in women with chronic HBV infection during low replication time. Methods A prospective study was conducted on the HBV reactivation index（HBeAg, HBV DNA and ALT） of pregnant women with chronic hepatitis B virus（HBV） infection from July 2014 to July 2015 in Beijing Ditan Hospital, Capital Medical University. Results Total of 520 chronic HBV infection pregnant and lying-in women with HBs Ag positive were selected, and out of whom 170 cases were in low replication time. A complete data analysis was conducted with 151 cases, among which 40 cases（26.49%） were with HBV reactivation, 8 cases（cumulative activation rate was 5.30%） were in the first trimester [（12 ± 1） weeks], 8 cases（cumulative activation rate was 10.60%） were in the second trimester [（24 ± 1） weeks], 10 cases（cumulative activation rate was 17.20%） were in the third trimester [（36 ± 1） weeks] and 14 cases were in postpartum（cumulative activation rate was 26.50%）. The difference was statistically significant（χ^2 = 29.821, P〈0.001）. Conclusions With the passage of time, the HBV cumulative reactivation rate of pregnant and lying-in women with chronic HBV infection during low replication time increased significantly. Therefore, the monitoring of HBV-related indicators should be concerned during the whole perinatal period to ensure the safety of maternal and child.