育龄期妇女慢性乙型肝炎诊治管理及母婴阻断策略

Diagnosis and treatment of chronic hepatitis B in women of child-bearing age and strategies for blocking mother-to-child transmission

慢性HBV感染者妊娠面临母婴两方面的问题,一是防治孕期肝炎活动,二是阻断母婴传播。对于HBeAg阳性母亲,出生不及时行联合免疫,婴儿的慢性HBV感染率高达90%。新生儿采用主动和被动联合免疫是预防HBV母婴传播安全而有效的措施,但是尽管采取了联合免疫,HBeAg阳性孕妇所生的婴儿仍有5%~10%感染HBV。妊娠期免疫系统变化,增加HBV复制,分娩后免疫系统激活,可致肝功能波动及慢性乙型肝炎患者病情加重,婴儿免疫失败则成为儿童及成人慢性乙型肝炎的源头。因此,对这部分特殊人群即HBV慢性感染育龄期妇女,特定的检测、干预及随访措施尤其值得关注和探讨。讨论了如何对育龄HBV感染的妇女进行整体系统的孕前、孕期及产后的管理,对孕妇及婴儿有效监测,通过疾病风险评估根据个体情况得到个体化的精确治疗,并对准备生育的慢性乙型肝炎感染者进行生殖和健康指导。

Women with chronic hepatitis B virus (HBV) infection face both maternal and child problems during pregnancy. One problem is to prevent hepatitis activities during pregnancy, and the other is to block mother-to-child transmission. Infants born to HBeAg-positive mothers may have a rate of chronic HBV infection of 90% if they do not receive combined immunization in time. The combination of hepatitis B vaccine and hepatitis B immunoglobulin for neonates is a safe and effective measure to prevent mother-to-child transmission of HBV. Although combined immunization is performed, infants born to HBeAg-positive mothers still have a rate of chronic HBV infection of 5%-10%. Changes in the immune system during pregnancy can increase the replication of HBV, and the activation of the immune system postpartum can lead to liver function fluctuation and aggravation of chronic hepatitis B patients. Immune failure in infants becomes the main cause of chronic hepatitis B in children and adults. Therefore, specific detection, intervention, and follow-up measures are worthy of attention and discussion for the special population of women of child-bearing age with chronic HBV infection. This article discusses the management of women of child-bearing age with chronic HBV infection before, during, and after pregnancy, the measures for effective monitoring of pregnant women and infants, and individualized therapy based on disease risk assessment and individual conditions. This article also provides reproductive and health guidance for women with chronic hepatitis B who are ready to give birth.