慢性乙型肝炎病毒携带状态孕妇抗病毒治疗停药后肝炎活动的相关因素分析

Related factors of hepatitis activity after antiviral treatment discontinuation in pregnant women with chronic HBV

目的探讨慢性乙型肝炎病毒(HBV)携带状态孕妇母婴抗病毒阻断后,停用抗病毒药物导致肝炎活动的相关因素。方法前瞻性分析我院及南通大学附属医院2016年1月至2020年1月就诊的慢性HBV携带状态孕妇93例,妊娠期给予抗病毒治疗,产后0~3个月停用抗病毒药物,分别于抗病毒治疗前、停用抗病毒药物后0、1、3及6个月随访肝功能、HBV⁃M及HBV⁃DNA滴度,了解停用抗病毒药物后肝炎活动情况及评估可能的相关因素。结果停用抗病毒药物后6个月内33例(35.48%)患者出现肝炎活动,根据6个月时肝功能状况,将观察对象分为肝炎活动组和无肝炎活动组。组间比较发现既往抗病毒治疗、合并自身免疫性疾病、第二次妊娠、抗病毒孕周、抗病毒药物(替比夫定及替诺福韦)、产后2⁃3个月停用抗病毒药物、抗病毒治疗时间及停用抗病毒药物时HBeAg滴度等存在统计学差异(P<0.05);多因素logistic回归分析发现停用抗病毒药物时HBeAg滴度水平与肝炎活动独立相关,其OR=3.253,P=0.025,95%CI:1.225~8.163),ROC曲线下面积为0.733,其最大约登指数为0.561,最佳临界值258 S/CO,对应的灵敏度、特异度分别为72.73%和83.33%(P<0.001,95%CI:0.632~0.820)。结论慢性HBV携带状态孕妇可于妊娠中晚期选用替诺福韦抗病毒阻断,动态监测HBeAg滴度可为抗病毒药物的停用提供临床参考。

Objective To study the related factors of postpartum discontinuation of mother infant antiviral blocking leading to hepatitis activity among pregnant women with chronic HBV.Methods A prospective analysis of pregnant women with HBV infections in our hospital and the Affiliated Hospital of Nantong University from January 2016 to January 2020 was conducted.Totally 93 pregnant women with chronic HBV that met the criteria were selected as the research subjects,and antiviral drugs were given during pregnancy,which should be stopped immediately or 1~3 months after delivery.Liver function,HBV⁃M and HBV⁃DNA titers were followed up before antiviral treatment,when antiviral drug was stopped,and 1 month,3 and 6 months after antiviral treatment discon⁃tinuation,to find out the status of hepatitis activity and possible related factors after antiviral treatment discontinua⁃tion.Results Thirty⁃three patients(35.48%)had hepatitis activity within six months after antiviral treatment discontinuation.According to the liver function 6 months after antiviral treatment discontinuation,the observation objects were divided into hepatitis activity group and hepatitis⁃free activity group.Comparison of related items between the two groups found that previous antiviral treatment,combined with autoimmune diseases,second preg⁃nancy,antiviral gestational weeks,antiviral drug(telbivudine and tenofovir),discontinuation of antiviral drugs 2~3 months postpartum,antiviral treatment time,and HBeAg titers when antiviral treatment discontinuation were statistically different(P<0.05).Multivariate logistic regression analysis found that HBeAg titer were independently correlated with hepatitis activity when antiviral drugs were discontinued(OR=3.253,P=0.025,95%CI:1.225~8.163).ROC curve analysis was used and showed that the area under the curve was 0.733;the maximum Youden index 0.561;the optimal critical value 258 S/CO,and the corresponding sensitivity and specificity were 72.73%and 83.33%respectively(P<0.001,95%CI:0.632~0.820).Conclusion Tenofovir can be used in pregnant women with chronic HBV in the second and third trimester of pregnancy for mother infant antiviral blocking.Dynamic monitoring of HBeAg titer could provide clinical reference for the discontinuation of antiviral.