育龄期慢性乙肝病毒感染者治疗策略和垂直传播风险探讨

目的探讨育龄期慢性乙肝病毒感染者治疗策略和垂直传播风险。方法回归分析某院门诊乙肝病毒感染者治疗效果及生育情况。结果慢性乙肝病毒携带和非活动性HBsA携带分别占21.6%和45.7%,不进行治疗生育。女性HBVDNA(-)感染者明显多于男性HBVDNA(+)感染者。没有用抗病毒治疗的患者病毒应答率、生化应答率、以及完全应答率明显低于抗病毒治疗患者(P﹤0.05或P﹤0.01),没有用抗病毒治疗的患者治疗失败率高于抗病毒治疗患者(P﹤0.05),停药后没有用抗病毒治疗患者全部复发,用抗病毒治疗患者停药后绝大部分复发(P﹤0.05)。没有用抗病毒治疗的男性和女性感染者预期生育失败率高于抗病毒治疗感染者(P﹤0.01)。女性较男性更担心病毒的垂直传播(P﹤0.01),女性慢性乙肝病毒携带生育子女HBsAg阳性5例(3.2%),男性生育子女无一例HBsAg阳性(P﹤0.01)。结论育龄期慢性乙肝病毒携带者不需要治疗可以正常妊娠,有肝功能异常者,如果通过保肝治疗能够维持肝功能指标正常或大致正常,权衡抗病毒治疗与生育利弊后,可以考虑先生育,感染者后代出生24h内通过预防接种乙肝疫苗和/或乙肝免疫球蛋白,女性垂直传播率非常低,父婴传播风险没有出现。

Research of treatment strategies and vertical transmission of reproductive age patients with chronic hepatitis b virus infection

OBJECTIVE To study treatment strategies and vertical transmission of reproductive age patients with chronic hepatitis B virus infection.METHODS Regression analysis was used to study the treatment effect and fertility status of reproductive age patients with hepatitis B virus infection.RESULTS 21.6% chronic hepatitis B virus carriers and 45.7% non-active HBsA had fertility without treatment.Female HBV DNA(-)infection was significantly more than male HBV DNA(+)infection.Virus response rate,biochemical response rate and complete response rate of patients without anti-virus treatment were significantly lower than those of patients with anti-virus treatment(P﹤0.05 or P﹤0.01).Treatment failure rate of patients without anti-virus treatment was significantly higher than that of patients with anti-virus treatment(P﹤0.05).All of patients treated without anti-virus treatment had recurrence,while most of patients with anti-virus treatment were recurrence(P﹤0.05).Expected birth failure rate of patients without anti-viral therapy was higher than patients with anti-virus treatment(P﹤0.01).More female than man worried about the vertical transmission of the virus(P﹤0.01).Female chronic hepatitis B virus carriers had 5 HBsA positive children(3.2%),and male patients had none HBsA positive children(P﹤0.01).CONCLUSION Reproductive age chronic hepatitis B virus carriers do not need treatment and can have normal pregnancy.Patients who have abnormal liver function consider fertility if the treatment can maintain normal liver function.Infected newborn within 24 hours should be vaccinated with hepatitis B vaccine and/or hepatitis B immune globulin,the vertical transmission rate can be very low.