孕期替比夫定治疗慢性HBV感染患者产后ALT升高的影响因素分析

Influence factors of telbivudine on postpartum ALT elevation in patients with chronic HBV infection during pregnancy

目的分析孕期采用替比夫定(telbivudine, LdT)抗病毒治疗的慢性HBV感染的产妇产后出现ALT升高的影响因素。方法回顾性分析2016年1月至2017年1月在首都医科大学附属北京佑安医院建档分娩且孕期曾采用替比夫定抗病毒治疗的HBV感染产妇103例,依据其产后6周ALT的水平分为3组。其中,A组62例,ALT≤1×检测值上限(upper limit of normal, ULN);B组27例,ALT为1～2×ULN;C组14例,ALT>2×ULN。收集资料并分析产后肝功能异常的影响因素。结果基线水平e抗原滴度较高、HBV-DNA载量较高、开始抗病毒的孕周较晚及分娩前ALT异常升高的患者,分娩后ALT升高的可能性增大,差异有统计学意义(P <0.05)。Logistic回归分析显示,分娩次数、基线e抗原滴度、分娩前ALT水平、开始抗病毒的孕周的相对危险度分别为2.291、1.001、1.035、1.224。结论对于多次分娩、基线水平病毒载量高、e抗原滴度较高、开始抗病毒的孕周较晚、分娩前ALT升高的产妇,产后6周门诊复查时,应警惕肝功能的异常,及时给予相应的治疗。

Objective To explore the influence factors of telbivudine on postpartum ALT elevation in patients with chronic HBV infection during pregnancy. Methods One hundred and three chronic HBV infected patients delivered in Beijing You’an Hospital of Capital Medical University from January 2016 to January 2017 were retrospectively collected.The enrolled patients were treated with telbivudine during pregnancy and were divided into three groups depended on the postpartum ALT level at 6 weeks after delivery： Group A（n=62）： ALT≤1 upper limit of normal（ULN）; Group B（n=27）：ALT 1～2 ULN; Group C（n=14）： ALT〉2 ULN. The factors that were related to the postpartum abnormal liver function were collected and analyzed. Results Patients with high baseline HBeAg titer, high HBV-DNA viral load, late onset of antiviral treatment, and abnormally elevated ALT before delivery had postpartum elevating ALT level. The differences were statistically significant（P 〈 0.05）. Logistic regression showed that the relative risks of the delivery times, baseline HBeAg level, prepartum abnormal ALT level, late onset of antiviral treatment were 2.291, 1.001, 1.035 and 1.224, respectively. Conclusion The chronic HBV infected patients who treated with telbivudine during pregnancy and had multiple deliveries, high baseline HBeAg level, prepartum abnormal ALT level and late onset of antiviral treatment should be cautious of abnormal liver function at the clinical follow-up 6 weeks after delivery.