[Impact of cessation of antiviral therapy at delivery on postpartum liver function in mothers with chronic hepatitis B virus infection].
[Impact of cessation of antiviral therapy at delivery on postpartum liver function in mothers with chronic hepatitis B virus infection].
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DOI：
10.3760/cma.j.issn.1007-3418.2019.02.008
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发表时间：
2019-02-20
影响因子：
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通讯作者：
Hu, J
中科院分区：
文献类型：
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作者：
Guo, H J;Gao, Y F;Hu, J
目的：探讨慢性乙型肝炎病毒感染母亲立即停止抗病毒治疗对产后肝功能的影响及产后异常的影响因素。方法：进行回顾性队列研究。 2014年6月至2018年6月纳入188例HBV DNA水平>2*106 IU/ml的孕妇。收集妊娠期、产时和产后的人口学信息以及肝功能和HBV DNA载量的临床数据。根据孕期抗病毒治疗建议，将女性分为三组，即替诺福韦（TDF）、替比夫定（LdT）和对照组。比较三组产后6个月内肝功能异常情况，并采用非条件Logistic回归分析影响肝功能异常的因素。结果：188例中，TDF组72例，LdT组80例，对照组36例。 TDF 和 LdT 组的孕妇从妊娠 28 ± 4 周直至分娩期间接受口服 TDF（300 mg/d）和 LdT（600 mg/d）。 188例患者中，30例（16.0%）产后肝功能异常。 TDF组、LdT组和对照组产后肝功能异常[丙氨酸转氨酶（ALT）> 2 *正常上限（ULN）]的发生率分别为19.4%、12.5%和16.7%。三组产后 ALT 峰值（中位、范围）分别为 34.5（12.0-946.0）U/L、37.5（12.0-733.8）U/L 和 39.0（7.0-513.0）U/L。三组间两项指标比较，差异均无统计学意义（P>0.05）。三组产后肝功能异常程度差异无统计学意义（P=0.944）。大多数肝功能异常为轻度至中度（2 * ULN≤ALT < 10 * ULN），通常可自行缓解或通过治疗缓解。单变量和多变量分析显示，妊娠期基线 ALT 水平是与产后肝功能异常相关的独立因素（OR = 1.031，CI 95%：1.005-1.058；chi(2) = 5.340，P = 0.021），而年龄、抗病毒治疗、HBeAg 阳性、基线 HBV DNA 水平、妊娠、产次、早产和 分娩方式与产后肝功能异常无显着相关性。结论：慢性HBV感染孕妇产后停止抗病毒治疗并不会显着增加产后肝功能异常的风险。妊娠期ALT水平是影响产后肝功能异常的因素。
Objective: To investigate the impact of immediate cessation of antiviral therapy on postpartum liver function and the factors influencing postpartum abnormality in mothers with chronic hepatitis B virus infection. Methods: A retrospective cohort study was conducted. One hundred eighty-eight pregnant women with HBV DNA level > 2*106 IU/ml were enrolled from June 2014 to June 2018. Demographic information and clinical data of liver function and HBV DNA load during gravidity, intrapartum and postpartum period were collected. According to the antiviral treatment recommendations during pregnancy, the women were divided into three groups, namely, tenofovir (TDF), telbivudine (LdT) and control group. Liver function abnormalities among the three groups were compared within 6 months after delivery, and the factors influencing abnormal liver function were analyzed by unconditional logistic regression. Results: Of the 188 cases, 72 cases were in the TDF group, 80 cases in the LdT group, and 36 cases in the control group. Pregnant women in the TDF and LdT groups received oral TDF (300 mg/d) and LdT (600 mg/d) from 28 ± 4 weeks of gestation till delivery. Among the 188 patients, 30 (16.0%) had abnormal postpartum liver function abnormality. The incidence of postpartum liver function abnormality [alanine aminotransferase (ALT) > 2 * upper limit of normal (ULN)] in the TDF, LdT, and control groups was 19.4%, 12.5%, and 16.7%, respectively. The postpartum peak levels of ALT (median, range) in the three groups were 34.5 (12.0-946.0) U/L, 37.5 (12.0-733.8) U/L, and 39.0 (7.0-513.0) U/L, respectively. There was no significant difference between the two indexes among the three groups (P > 0.05). There was no statistically significant difference in the degree of postpartum liver function abnormalities between the three groups (P = 0.944). Most of the liver function abnormalities were mild to moderate (2 * ULN≤ALT < 10 * ULN), and usually resolved spontaneously or by treatment. Univariate and multivariate analysis showed that baseline ALT level during pregnancy was an independent factor associated with postpartum liver function abnormality (OR = 1.031, CI 95%: 1.005-1.058; chi(2) = 5.340, P = 0.021), whereas age, antiviral therapy, HBeAg-positivity, baseline HBV DNA levels, gravidity, parity, preterm delivery and delivery mode were not significantly associated with postpartum liver function abnormality. Conclusion: Cessation of antiviral therapy after delivery did not significantly increase the risk of postpartum liver function abnormality in pregnant women with chronic HBV infection. The ALT level during pregnancy is a factor influencing postpartum liver function abnormality.