慢性乙型肝炎病毒感染孕妇产后继续抗病毒治疗发生乙型肝炎e抗原血清学转换的影响因素分析

doi:10.19871/j.cnki.xfcrbzz.2025.05.011

摘要/Abstract

摘要： 目的了解处于免疫耐受期、在妊娠中期接受核苷（酸）类似物[nucleos(t)ide analogues,NAs]治疗的乙型肝炎e抗原（hepatitis B virus e antigen,HBeAg）阳性慢性乙型肝炎病毒（hepatitis B virus,HBV）感染孕妇产后NAs治疗的HBeAg血清学转换率,分析发生HBeAg血清学转换的独立影响因素。方法本研究纳入2014年1至2020年12月间在西安交通大学第一附属医院及汉中市三二〇一医院就诊的HBeAg阳性、孕期丙氨酸氨基转移酶（alanine amino-transferase,ALT）低于正常值上限2倍、在妊娠中期接受NAs治疗、产后继续NAs治疗的慢性HBV感染孕妇161例。根据其产后有无发生HBeAg血清学转换分为转换组（45例）与未转换组（116例）,通过单因素分析和多因素logistic回归分析HBeAg血清学转换的独立影响因素。结果 27.95%（45/161）的慢性HBV感染孕妇产后96周内发生HBeAg血清学转换。转换组的基线ALT、天冬氨酸氨基转移酶（aspartate aminotransferase,AST）水平均显著高于未转换组（P<0.05）,乙型肝炎表面抗原（hepatitis B virus surface antigen,HBsAg）滴度、HBeAg滴度均显著低于未转换组（P<0.05）,转换组妊娠中期至产前HBeAg、HBV DNA的降幅和下降率均高于未转换组（P<0.05）。单因素和多因素logistic回归分析显示,妊娠中期到产前的HBV DNA下降率（OR=1.035,95%CI：1.005~1.065,P=0.023）和HBeAg滴度下降率（OR=1.056,95%CI：1.025~1.087,P<0.001）是产后发生HBeAg血清学转换的独立影响因素。结论在孕中期进行NAs治疗的HBeAg阳性慢性HBV感染孕妇,产后继续NAs抗病毒治疗发生HBeAg血清学转换的可能性增加。妊娠中期到产前的HBV DNA载量、HBeAg滴度下降得越多,产后持续NAs发生HBeAg血清学转换的可能性越大,这为临床医生在评估慢性HBV感染孕妇的产后病情及制订管理策略时提供参考依据。

关键词: 乙型肝炎e抗原, 乙型肝炎病毒, 乙型肝炎病毒脱氧核糖核酸, 母婴传播, 核苷（酸）类似物, 影响因素

Abstract: Objective To understand the rate of hepatitis B virus e antigen (HBeAg) seroconversion in chronic hepatitis B virus (HBV)-infected pregnant women in the immune-tolerant phase and receive nucleos(t)ide analogues (NAs) therapy in mid-pregnancy and continue NAs therapy after delivery,and to explore independent factors influencing HBeAg seroconversion. ^Method This was a case-control study that included 161 pregnant women with chronic HBV infection who were HBeAg positive, had an alanine aminotransferase (ALT) less than twice the upper limit of normal during pregnancy, were treated with NAs in mid-pregnancy, and continued NAs after delivery in The First Affiliated Hospital of Xi'an Jiaotong University and the 301 Hospital between January 2014 and December 2020. They were divided into a conversion group and a non-conversion group according to whether they had or had not occurred HBeAg seroconversion in the postpartum period, and the independent influencing factors of HBeAg seroconversion were analyzed using univariate analysis and multivariate logistic regression model. Result 27.95% of chronically HBV-infected pregnant women had HBeAg seroconversion within 96 weeks postpartum. The levels of baseline ALT and aspartate aminotransferase (AST) in the conversion group were significantly higher than those in the non-conversion group (P<0.05). The titers of HBeAg were significantly lower than those in the non-conversion group (P<0.05), and the reductions and reduction rates of HBeAg and hepatitis B virus DNA(HBV DNA) in the conversion group from the second trimester to the prenatal period were higher than those in the non-conversion group (P<0.05). Univariate and multivariate logistic regression analysis showed that the rate of decline in hepatitis B virus DNA(HBV DNA) from mid-pregnancy to prenatal period (OR=1.035,95%CI：1.005-1.065,P=0.023) and the rate of decline in HBeAg(OR=1.056,95%CI：1.025-1.087,P<0.001) were the independent influencing factors for the occurrence of HBeAg seroconversion postpartum. Conclusion HBeAg-positive pregnant women with chronic HBV who are given NAs treatment antiviral therapy from mid-pregnancy to after delivery are more likely to develop HBeAg seroconversion. The greater the decrease in HBV DNA load and HBeAg titer from mid-pregnancy to prenatal period, he higher the likelihood of HBeAg seroconversion with continuous postpartum NA therapy, which provides a valuable reference for clinicians in evaluating the postpartum condition of chronic HBV-infected pregnant women and developing management strategies.

Key words: Hepatitis B virus e antigen, Hepatitis B virus, Hepatitis B virus DNA, Mother to child transmission, Nucleoside (acid) analogues, Influencing factor

中图分类号:

R512.6

魏丽, 钟文婷, 皇甫彤, 郑婕, 饶珂萌, 陆长春, 周娇, 陈天艳, 蔺咏梅. 慢性乙型肝炎病毒感染孕妇产后继续抗病毒治疗发生乙型肝炎e抗原血清学转换的影响因素分析[J]. 新发传染病电子杂志, 2025, 10(5): 59-63.

Wei Li, Zhong Wenting, Huang Futong, Zheng Jie, Rao Kemeng, Lu Changchun, Zhou Jiao, Chen Tianyan, Lin Yongmei. Analysis of factors influencing the occurrence of HBeAg seroconversion in chronic HBV-infected pregnant women continuing antiviral therapy after delivery[J]. Electronic Journal of Emerging Infectious Diseases, 2025, 10(5): 59-63.

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