非活动性HBsAg携带孕妇慢乙肝急性发作合并ICP一例报告

Inactive HBsAg positive pregnant woman presented with acute exacerbation of chronic hepatitis B complicated with intrahepatic cholestasis of pregnancy: a case report

非活动性HBs Ag携带孕妇慢性乙型肝炎(慢乙肝)急性发作合并妊娠期肝内胆汁淤积症(ICP)较为少见。该文报道了1例HBe Ag阴性的非活动性HBs Ag携带孕妇,在孕30+6周起出现乏力、食欲减退、恶心,查HBV DNA水平升高,随后出现ALT异常,伴皮肤瘙痒,予替诺福韦抗病毒治疗,服药后乏力、食欲减退较前改善,仍有皮肤瘙痒。患者血清HBV DNA、ALT在孕37周达到高峰,且总胆红素明显升高,诊断为慢乙肝急性发作合并ICP,于孕38周行剖宫产终止妊娠,分娩一正常女婴,产后患者瘙痒症状迅速消失,恶心、乏力缓解,食欲、肝功能好转,继续应用替诺福韦抗病毒治疗,随访示其HBV DNA低于检测限,肝功能恢复正常。该例诊治经过提示,对非活动性HBs Ag携带孕妇应密切监测,警惕其慢乙肝急性发作,如发现合并ICP,应适时终止妊娠,有利于母婴妊娠结局。

Inactive HBsAg positive pregnant woman with acute exacerbation of chronic hepatitis B complicated with intrahepatic cholestasis of pregnancy （ICP） are rarely encountered in clinical practice. In this study, one inactive HBsAg positive and hepatitis B e-antigen （HBeAg）negative pregnant womanwas reported. She developed fatigue, loss of appetite and nausea at a gestational age of 30＋6 weeks. Hepatitis B virus （HBV） DNA level was increased and abnormal alanine aminotransferase （ALT） level was detected. She presentedskin pruritus. After the administration of tenofovir disoproxil fumarate, the symptoms of fatigue and loss of appetite were alleviated, whereas the skin pruritus still existed. The HBV DNA and ALT levels peaked at the gestational age of 37 weeks and the total bilirubin level was significantly increased. The patient was diagnosed with acute exacerbation of chronic hepatitis B complicated with ICP and then delivered a girl by cesarean section. After delivery, the skin pruritus was rapidly disapeared, nausea, fatigue, loss of apetite and liver function were improved. She continuedtenofovir disoproxil fumarate therapy. During follow-up, the HBV DNA level was lower than the detection limit and the liverfunctions werenormal. The diagnosis and treatment of this case showed that intimate monitoring should be performed for inactive HBsAg positive pregnant woman to prevent the acute onset of chronic hepatitis B. Pregnancy termination should be immediately done after the diagnosis of ICP to enhance the maternal and fetal prognosis.