孕期乙型肝炎活动患者抗病毒治疗对妊娠结局的影响

目的探讨孕期乙型肝炎活动患者抗病毒治疗对妊娠结局的影响。方法研究对象为2006年8月至2011年4月就诊于北京地坛医院妇产科、妊娠8～24周发现肝功能异常(丙氨酸转氨酶≥3×正常值上限)且HBV DNA≥5 lg拷贝/ml的患者,根据患者的意愿分为抗病毒治疗(拉米夫定或替比夫定)组和保肝治疗(多烯磷脂酰胆碱、腺苷蛋氨酸、还原型谷胱甘肽、肝喜乐片、利肝康片等)组,比较2组患者的妊娠期肝病结局、严重不良事件和新生儿结局。结果共纳入102例患者,抗病毒治疗组56例,保肝治疗组46例。2组患者基线资料比较差异无统计学意义(P>0.05)。抗病毒治疗组失访3例,53例完成生育;保肝治疗组失访5例,2例终止妊娠,2例妊娠失败,37例完成生育。抗病毒治疗组产前ALT复常率和HBV DNA阴转率均明显高于保肝治疗组90.6%(48例)比18.9%(7例),58.5%(31例)比8.1%(3例);均P=0.000];自然/人工终止妊娠率和非生育住院率均明显低于保肝治疗组0比9.8%(4例),P=0.020;7.5%(4例)和26.3%(10例),P=0.023];因肝功能异常住院率2组比较差异无统计学意义(P=0.061)。抗病毒治疗组53胎新生儿中46例完成全程免疫,无一例阻断失败;保肝治疗组37胎新生儿中30例完成全程免疫,3例(10.0%)HBsAg阳性。2组新生儿HBV母婴阻断成功率差异有统计学意义(P=0.029)。结论 HBV感染女性妊娠期发生活动性肝炎选择拉米夫定或替比夫定治疗对母亲和胎儿是安全、有效的,可有效抑制HBV复制,降低丙氨酸转氨酶水平,减少HBV母婴传播的风险。

Influence of antiviral therapy on pregnancy outcome in active hepatitis B patients during pregnancy

Objective To explore the influence of antiviral therapy on pregnancy outcome in active hepatitis B patients during pregnancy. Methods The patients, who were in 8-24 weeks of pregnancy and had abnormal liver function alanine aminotransferase （ALT） ≥3 x upper limit of normal] and HBV DNA level i〉5 lg copies/m1 in the department of gynaecology and obstetrics, Beijing Ditan Hospital, Capital Medical University from August 2006 to April 2011, were selected. According to the patients＇ will, they were divided into the antiviral treatment group receiving ]amivudine or telbivudine and the liver-protective treatment group receiving polyene phosphatidyl choline, adenosylmethionine, glutathione, Ganxile （~]J（~r~） tablets and Ligankang （~lJ ~）~） tablets etc. The liver disease outcome during pregnancy, severe adverse events and neonates＇ outcome in the 2 groups were compared. Results A total of 102 patients were entered in this study. Of them, 56 patients were in the antiviral treatment group and 46 patients were in the liver- protective treatment group. There were no statistically significant differences in baseline characteristics of patients between the 2 groups （ P 〉 0.05 ）. Fifty-three patients completed pregnancy and 3 patients lost from follow-up in the antiviral treatment group. Thirty-seven patients completed pregnancy in the liver-protective treatment group. Of the other 9 patients, 5 patients lost from follow-up, 2 selected artificial termination of pregnancy, and 2 patients＇ pregnancy failed. The rate of ALT levels returning to normal 90.6% （ 48 patients） ] and the rate of HBV DNA levels changing to negative 58.5% （31 patients） before delivery in the patients in the antiviral treatment group were higher than those 18.9% （7 patients） , 8.1% （ 3 patients） ] in the liver-protective treatment group （ P = 0. 000 for all comparisons）. The rates of natural or artificial termination of pregnancy （0） and non-birth-related hospitalization 7.5% （4 patients）] in the patients in the antiviral treatment group were markedly lowered than those 9. 8% （4 patients）, 26.3% （ 10 patients） ] in the liver-protective treatment group （ P = 0. 020, P = 0. 023 ）. There were no significant differences in the rate of hospitalization due to abnormal liver function between the 2 groups （P = 0.061 ）. Of the 53 neonates in the antiviral treatment group, 46 completed the whole course of immunization and no neonate failed; of the 37 neonates in the liver-protective treatment group, 30 completed the whole course of immunization and 3 neonates （ 10.0% ） were HBsAg-positive. The difference in the blocking rates of mother-to-child transmission in the neonates between the 2 groups was statistically significant （ P = 0. 029）. Conclusion Lamivudine or telbivudine treatment used in active hepatitis B patients during pregnancy is safe and effective for mother and fetus. The treatment could inhibit effectively HBV replication, decrease ALT levels, and reduce the risk of HBV mother-to-child transmission.