[Impact of cessation of antiviral therapy at delivery on postpartum liver function in mothers with chronic hepatitis B virus infection].

• DOI: 10.3760/cma.j.issn.1007-3418.2019.02.008
• Publication Date: 2019-02-20
• Authors: Huijie Guo; Yunfei Gao; Huiyuan Liu; Haitang He; Mei‐Ting Huang; Dan-Chun Cai; Dandan Liao; Jinna Li; Xueru Yin; Zhihua Liu; Jing Hu
• Keywords: Liver function; Telbivudine; Hepatitis B

Objective: To investigate the impact of immediate cessation antiviral therapy on postpartum liver function and factors influencing abnormality in mothers with chronic hepatitis B virus infection. Methods: A retrospective cohort study was conducted. One hundred eighty-eight pregnant women HBV DNA level > 2×106 IU/ml were enrolled from June 2014 to 2018. Demographic information clinical data load during gravidity, intrapartum period collected. According treatment recommendations pregnancy, divided into three groups, namely, tenofovir (TDF), telbivudine (LdT) control group. Liver abnormalities among groups compared within 6 months after delivery, abnormal analyzed by unconditional logistic regression. Results: Of 188 cases, 72 cases TDF group, 80 LdT 36 Pregnant received oral (300 mg/d) (600 28 ± 4 weeks gestation till delivery. Among patients, 30 (16.0%) had abnormality. The incidence [alanine aminotransferase (ALT) 2 × upper limit normal (ULN)] TDF, LdT, 19.4%, 12.5%, 16.7%, respectively. peak levels ALT (median, range) 34.5 (12.0-946.0) U/L, 37.5 (12.0-733.8) 39.0 (7.0-513.0) There no significant difference between two indexes (P 0.05). statistically degree = 0.944). Most mild moderate (2 ULN≤ALT < 10 ULN), usually resolved spontaneously or treatment. Univariate multivariate analysis showed that baseline pregnancy an independent factor associated (OR 1.031, CI 95%: 1.005-1.058; χ(2) 5.340, P 0.021), whereas age, therapy, HBeAg-positivity, levels, parity, preterm delivery mode not significantly Conclusion: Cessation did increase risk is a abnormality.目的： 探讨妊娠期抗病毒治疗的慢性乙型肝炎病毒（HBV）感染孕妇分娩后立即停药对产后肝功能的影响及产后肝功能异常的影响因素。 方法： 采用回顾性队列研究，于2014年6月至2018年6月纳入188例慢性HBV感染且HBV 2×10(6) IU/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，按孕期抗病毒治疗情况分为替诺福韦酯（TDF）组、替比夫定（LdT）组和未抗病毒对照组，比较三组孕妇产后6个月内肝功能异常情况，并采用非条件logistic回归分析产后肝功能异常的影响因素。 结果： 纳入的188例孕妇中，TDF组72例、LdT组80例和对照组36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）至分娩后停药。188例孕妇中有30例（16.0%）产后出现肝功能异常。TDF组、LdT组和对照组产后肝功能异常[丙氨酸氨基转移酶（ALT）≥ 2×正常值上限（ULN））]的发生率分别为19.4%、12.5%和16.7%，产后ALT峰值水平中位数（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，两指标在三组间差别均无统计学意义（P值均> 0.05）。三组孕妇产后肝功能异常程度差异无统计学意义（P 0.944），绝大多数的肝功能异常均为轻中度异常（2×ULN≤ALT 10×ULN），且通常经抗病毒治疗和/或护肝治疗后好转，也可自行好转。经多因素分析，孕期基线ALT水平是产后肝功能异常的独立影响因素（比值比= 95%可信区间为1.005～1.058，P 0.021），年龄、抗病毒治疗、HBeAg阳性、基线HBV DNA水平、孕次、产次、早产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感染孕妇分娩后停用抗病毒药未明显增加产后肝功能异常的风险，妊娠期ALT水平是产后肝功能异常的影响因素。.