接受母婴阻断治疗的慢性HBV感染孕妇产后肝炎发作的风险预测模型构建

Construction of a risk prediction model for postpartum hepatitis flare in HBV-infected pregnant women with mother-to-child transmission prevention.

目的:探讨慢性HBV感染孕妇以母婴阻断为目的抗病毒治疗产后肝炎发作的危险因素并构建风险预测模型。方法:纳入2020年1月至2022年10月在上海市公共卫生临床中心产检及分娩的198例慢性HBV感染孕产妇,随访至产后48周,根据随访结束时患者是否肝炎发作,将患者分为肝炎发作组40例(肝炎发作组)和未发作组158例(对照组)。基于两组患者的一般临床资料和开始抗病毒前血清丙氨酸氨基转移酶(ALT)、乙肝病毒DNA定量(HBV DNA)、乙肝表面抗原(HBsAg)、乙肝e抗原(HBeAg)及乙型肝炎病毒核心相关抗原(HBcrAg)定量水平,分析慢性HBV感染孕妇抗病毒治疗产后肝炎发作的危险因素,并构建风险预测模型。结果:肝炎发作组与对照组开始抗病毒前血清ALT、HBcrAg、HBsAg、HBeAg及HBV DNA水平比较,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,抗病毒前较高的血清HBcrAg、HBsAg、HBeAg及HBV DNA水平是影响慢性HBV感染孕产妇产后肝炎发作的独立危险因素(P<0.05)。这些独立危险因素对产后肝炎发作有良好的预测价值,且四者联合诊断预测价值更高(AUC=0.953)。结论:联合检测开始抗病毒前血清HBcrAg、HBsAg、HBeAg及HBV DNA水平对慢性HBV感染孕产妇产后肝炎活动有良好的预测意义,可为临床随访和决策提供参考。

Objective:To investigate the risk factors and develop a model for predicting postpartum hepatitis flare in chronic hepatitis B virus infected pregnant women with mother-to-child transmission prevention.Methods:One hundred and ninety-eight patients who were treated for mother-to-child transmission prevention and delivered in Shanghai public health clinical center from January 2020 to October 2022 were involved in our study.Patients were divided into hepatitis flare group(40 cases)and control group(158 cases)according to whether there was postpartum hepatitis flare exist.Based on patients'clinical data,and the levels of ALT,HBV DN2A,HBsAg,HBeAg and HBcrAg before given antivirals,the risk factors and prediction model was constructed.Result:There was a statistically significant difference between the hepatitis flare group and the control group in terms of the levels of ALT,HBV DNA,HBsAg and HBcrAg before starting the antiviral therapy(P<0.05).Logistic regression analysis showed that higher levels of HBV DNA,HBsAg and HBcrAg before starting the antiviral therapy were independent risk factors(P<0.05).Those independent risk factors had good predictive value for patients with postpartum hepatitis flare,and the combined diagnostic predictive value of the four was higher(AUC=0.953).Conclusions:Joint detection of the levels of ALT,HBV DNA,HBsAg and HBcrAg before starting the antiviral therapy have certain predictive value for postpartum hepatitis flare in HBV-infected pregnant women with mother-to-child transmission prevention,and can provide evidence for clinical close monitoring and decision-making.