摘要
目的 探讨孕期采用核苷(酸)类似物抗病毒的慢乙肝高病毒载量孕产妇产后合适的停药时间。方法 选择2020年1月-2021年12月本院收治的81例慢性HBV感染且HBV DNA> 2×105IU/ml的孕妇为研究对象,收集人口学信息,妊娠期、分娩、产后的肝功能及HBV DNA载量等临床数据,按孕期抗病毒及产后是否停药情况分为替诺福韦酯(TDF)产后立即停药组(A组)、替诺福韦酯(TDF)产后1-3个月停药组(B组)、替比夫定(LdT)产后立即停药组(C组)、替比夫定(LdT)产后1-3个月停药组(D组),比较四组孕妇产后6个月内肝功能异常率。结果 纳入的81例孕妇中,TDF组42例、LdT组39例。TDF组和LdT组孕妇从妊娠(28±4)周(基线)开始分别口服TDF(300 mg/d)和LdT(600 mg/d),其中孕期口服TDF的30例产后立即停药,另12例产后1-3月停药。其中孕期口服LdT的25例产后立即停药,另14例产后1-3个月停药。81例孕妇中有14例(17.3%)产后出现肝功能异常。替诺福韦酯(TDF)产后立即停药组(A组)、替诺福韦酯(TDF)产后1-3个月停药组(B组)、替比夫定(LdT)产后立即停药组(C组)、替比夫定(LdT)产后1-3个月停药组(D组)四组产后肝功能异常[丙氨酸氨基转移酶(ALT)≥2×正常值上限(ULN)]的发生率分别为20%、16.7%、16%和14.3%,组间比较无明显差异,产后ALT峰值水平中位数(范围)分别为34.2 (11.0-863.0) U/L、36.3 (8.0-791.0) U/L、34.4 (8.0-811.0) U/L和38.0(7.0-619.0)U/L,两指标在四组间差别均无统计学意义(P值均>0.05)。四组孕妇产后肝功能异常程度差异无统计学意义(P=0.914),且绝大多数的肝功能异常均为轻中度异常(2×ULN≤ALT <10×ULN),且通常经继续抗病毒治疗和/或护肝治疗后好转,也可自行好转。抗病毒治疗基线ALT、HBeAg、HBV DNA水平、年龄、孕次、产次、胎龄和分娩方式均与产后肝功能异常无显著相关性。结论 慢性HBV感染以阻断母婴传播为目的口服核苷(酸)类似物抗病毒治疗的孕妇
Objective To investigate the appropriate time of drug withdrawal of nucleoside analogues in pregnant women suffered from CHB with high viral load after delivery.Methods From January 2020 to December 2021,a prospective clinical cohort was established to enroll pregnant women suffered from CHB with HBV DNA load over 2×105 IU/ml and analyze the demographic information,liver function and HBV DNA during pregnancy,delivery,and postpartum.According to the different use of antiviral drugs and the opportunity of drug withdrawal after delivery,they were divided into four groups,group A took tenofovir dipivoxil(TDF)and withdrawal immediately after delivery,group B took TDF until 1 to 3 months after delivery,group C took telbivudine(LdT)until the time of delivery,group D took LdT until 1 to 3 months after delivery.The abnormal rate of liver function within 6 months after delivery was compared among the four groups.Results Among the 81 pregnant women enrolled,42 cases were in TDF group and 39 cases were in LdT group.They started to take TDF(300 mg/d)and LdT(600 mg/d)at 28±4 weeks on average,respectively.30 women in TDF group stopped taking TDF immediately after delivery,and the other 12 women in TDF group took TDF until 1 to 3 months after delivery.25 cases in LdT group stopped taking LdT immediately after delivery,the remaining 14 cases in TDF group took LdT until 1 to 3 months after delivery.The liver function abnormality was 17.3%(14 cases)in total among the 81 patients.The incidence of abnormal liver function(concentration of alanine aminotransferase(ALT)over or equal to two times of upper limit of normal(ULN))in groups A,B,C and D were 20%,16.7%,16%and 14.3%,respectively.And there was no significant difference among the groups.The median peak ALT levels after delivery(range)were 34.2(11.0-863.0)U/L,36.3(8.0-791.0)U/L,34.4(8.0-811.0)U/L and 38.0(7.0-619.0)U/L in groups A,B,C and D.There was no significant difference in the two indexes among the four groups(P>0.05).There was no significant difference in abnormality exten
作者
葛春燕
尤春霞
王晓燕
Ge Chunyan;You Chunxia;Wang Xiaoyan(Nantong Third People's Hospital(Affiliated Nantong Hospital 3 of Nantong University),Nantong,Jiangsu,226000,China.)
出处
《齐齐哈尔医学院学报》
2023年第7期635-640,共6页
Journal of Qiqihar Medical University
基金
南通市卫生健康委员会科研立项课题(QB2019008)。
关键词
慢性乙型肝炎携带孕妇
母婴阻断
停药安全性
Pregnant woman chronically infected with Hepatitis B virus
Mother-to-child transmission interruption
Safety of drug withdrawal
