替诺福韦酯阻断HBV母婴传播停药后产妇ALT复发的特征及预测因素

Characteristics and predictors of ALT flare in postpartum women with tenofovir blocking mother-to-child transmission of HBV after drug discontinuation

目的观察高病毒载量慢性HBV感染孕妇经孕期抗HBV干预以阻断HBV母婴传播, 分娩停药后产妇谷丙转氨酶(alanine transaminase, ALT)复发的特征及预测因素。方法招募深圳市第三人民医院肝病门诊符合纳入标准及排除标准的慢性HBV感染孕产妇, 收集孕期使用抗HBV药物前后资料, 产后定期4~6周、12周、36周、48周、72周、96周的随访, 完善肝功能、HBV血清学标志物、HBV DNA定量等检查。比较产后ALT正常组与异常组特点, logistic回归分析产后ALT异常升高的风险因素。结果 2018年9月1日至2020年12月31日收集到100例产妇, 94例慢性HBV感染产妇均在产后12周内出现病毒学复发, 并持续HBeAg阳性。发生ALT异常升高者达60%, 大部分发生于产后12~24周内, 大部分可自行恢复至正常水平, 但产后48~96周仍有27%的发生ALT升高。产后ALT≥5×ULN(upper limits of normal)再次启动抗病毒治疗的共24例。logistic多因素回归分析, 提示分娩停药产后ALT异常升高(>ULN)与分娩时ALT升高相关, 优势比为1.089。结论分娩停药后产妇ALT异常升高频率较高, 大部分可自行恢复正常, 但产后48周后仍有ALT异常升高且需再次抗病毒治疗者, 因此高病毒载量慢性HBV感染孕妇分娩停药后需要规范长期随访。

Object To observe the characteristics and predictors of alanine aminotransferase(ALT)flare in postpartum women with chronic HBV infection and high viral load who were prevented from mother-to-child transmission of HBV by anti-HBV intervention during pregnancy.Methods Data of pregnant women seen at the Third People’s Hospital of Shenzhen liver disease outpatient clinic who met inclusion and exclusion criteria of chronic hepatitis B virus(HBV)infection were collected,including data recorded before and after antiviral therapy during pregnancy,postpartum regular 4 to 6 weeks,12,36,48,72,and 96 weeks of follow-up,results of liver function tests,HBV serological markers and HBV DNA quantitative examinations.The characteristics of normal and abnormal postnatal ALT groups were compared,and the risk factors of abnormal postnatal ALT were analyzed by logistic regression.Results A total of 100 women with chronic HBV infection were enrolled from September 1,2018 to December 31,2020.All 94 women with chronic HBV infection experienced virological recurrence within 12 weeks after delivery and continued to be HBeAg positive.The rate of ALT flare(>ULN)was 60%,most of which occurred within 12-24 weeks after delivery,and most of which returned to normal without special treatment.However,ALT flare still occurred in 27%of cases within 48-96 weeks after delivery.A total of 24 patients with postnatal ALT≥5×ULN were treated with antiviral therapy again.Logistic multifactor regression analysis suggested that elevation of ALT(>ULN)after delivery and drug discontinuation was associated with ALT elevation occurred during delivery,the odds ratio(OR)was 1.089.Conclusions ALT flare in postpartum women is common,and most of them can return to normal without special treatment.However,ALT flare still occurs after 48 weeks of delivery,and antiviral therapy is needed again.Therefore,long-term follow-up should be standardized for pregnant women with high viral load and chronic HBV infection after delivery.