慢性HBV携带孕妇产后自发HBeAg和HBsAg血清清除或转换的病毒学因素分析*

doi:10.3969/j.issn.1672-5069.2014.04.011

实用肝脏病杂志 ›› 2014, Vol. 17 ›› Issue (4): 376-380.doi: 10.3969/j.issn.1672-5069.2014.04.011

慢性HBV携带孕妇产后自发HBeAg和HBsAg血清清除或转换的病毒学因素分析^*

冯振华, 张姝, 刘景丽, 毕永春, 夏挺, 许碧云, 胡娅莉, 周乙华

210008 南京市南京大学医学院附属鼓楼医院科研部（冯振华,刘景丽,周乙华）; 检验科（毕永春,夏挺）; 妇产科（张姝,胡娅莉）; 统计室（许碧云）

收稿日期:2013-12-23 出版日期:2014-08-30 发布日期:2016-04-11
通讯作者: 周乙华,E-mail：zgr03summer@126.com
作者简介:冯振华,女,30岁,硕士研究生,研究实习员。主要从事病毒性肝炎的研究。E-mail：fengzhenhua1222@163.com
基金资助:
南京市第一层次卫生人才项目（编号：2011024）; 南京大学医学院附属鼓楼医院青年科研启动基金（编号：QJ2012013）

Virologic determinants of postpartum spontaneous HBeAg and/or HBsAg seroclearance or seroconversion in pregnant women who are chronic hepatitis B virus carriers

Feng Zhenhua, Zhang Shu, Liu Jingli

Departments of Scientific Research,Nanjing Drum Tower Hospital,Affiliated to Nanjing University Medical School,Nanjing 210008,Jiangsu Province,China

Received:2013-12-23 Online:2014-08-30 Published:2016-04-11

摘要/Abstract

摘要： 目的探讨影响慢性乙型肝炎病毒（HBV）携带孕妇产后自发HBeAg和HBsAg血清清除或转换的相关病毒学特征。方法2002年8月~2004年7月本院诊断的慢性HBV携带孕妇,自2009年10月~2010年3月间随访,检测HBV血清学标志和病毒相关特性。结果在本组419例慢性HBV携带孕妇中,经随访平均6.4年,失访155例。在接受随访的264例（63.0%）中,76例（28.8%）孕期在入组时HBeAg阳性,其中42例（55.3%）随访时发生自发HBeAg转换,这些孕妇孕期HBV DNA、HBeAg 和HBsAg均低于34例未转换组（P值均<0.01）。在6例血清HBV DNA <1×10⁶ IU/ml、17例HBeAg <700 S/CO和13例HBsAg <1×10⁴ IU/ml孕妇中,随访时自发HBeAg转换分别高达100.0%、100.0%和92.3%。随访时,38例（14.4%）孕妇自发HBsAg清除,HBsAg清除组孕期HBsAg水平明显低于226例未清除组（P<0.001）。在25例血清HBsAg <100 IU/mL孕妇中,随访时56.0%自发HBsAg清除。结论外周血HBV DNA载量低（<1×10⁶ IU/ml）、HBeAg水平低（<700 S/CO）或HBsAg水平低（<1×10⁴ IU/ml）是自发HBeAg血清转换的有利因素,而当HBsAg <100 IU/mL时,更易发生自发HBsAg血清清除。

关键词: 乙型肝炎病毒携带者, 孕妇, HBeAg血清学转换, HBsAg血清学清除

Abstract: Objective To study the virologic determinants of spontaneous seroclearance or seroconversion of HBeAg and/or HBsAg in pregnant women who are chronic hepatitis B virus （HBV） carriers. Methods The pregnant women diagnosed as chronic HBV carriers between August,2002 and July,2004 were included and followed up between October,2009 and March,2010. The HBV serologic markers and HBV DNA were detected. Results A total of 419 individuals were recruited in this study,and the average follow-up period was 6.4 years. Although 155 women lost,a total of 264（63.0%） women were successfully followed up,of whom 76 （28.8%） were HBeAg-positive at presentation. 55.3% （42/76） of HBeAg-positive women were seroconverted to anti-HBe spontaneously at the follow-up. Compared with 34 women without seroconversion,42 with HBeAg/anti-HBe seroconversion had lower levels of serum HBV DNA,HBeAg and HBsAg（all P<0.01）. The postpartum HBeAg seroconversion rate in 6 pregnant women with HBV DNA <1×10⁶ IU/ml,17 with HBeAg <700 S/CO,and 13 with HBsAg<1×10⁴ IU/ml were 100.0%,100.0% and 92.3%,respectively. The spontaneous HBsAg seroclearance was found in 38 （14.4%） women at the follow-up. The serum HBsAg levels at presentation were significantly lower in women with HBsAg seroclearance than 226 without HBsAg seroclearance （P<0.001）. The postpartum HBsAg seroclearance rate in 25 pregnant women with HBsAg <100 IU/ml was as high as 56.0%. Conclusions HBeAg-positive women with serum HBV DNA <1×10⁶ IU/ml,HBeAg <700 S/CO and/or HBsAg <1×10⁴ IU/ml are more likely to undergo spontaneous HBeAg seroconversion,and those with serum HBsAg <100 IU/ml have a higher chance of spontaneous HBsAg seroclearance.

Key words: Hepatitis B virus carrier, Pregnant women, HBeAg seroconversion, HBsAg seroclearance

冯振华, 张姝, 刘景丽, 毕永春, 夏挺, 许碧云, 胡娅莉, 周乙华. 慢性HBV携带孕妇产后自发HBeAg和HBsAg血清清除或转换的病毒学因素分析^*[J]. 实用肝脏病杂志, 2014, 17(4): 376-380.

Feng Zhenhua, Zhang Shu, Liu Jingli. Virologic determinants of postpartum spontaneous HBeAg and/or HBsAg seroclearance or seroconversion in pregnant women who are chronic hepatitis B virus carriers[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2014, 17(4): 376-380.

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慢性HBV携带孕妇产后自发HBeAg和HBsAg血清清除或转换的病毒学因素分析^*

Virologic determinants of postpartum spontaneous HBeAg and/or HBsAg seroclearance or seroconversion in pregnant women who are chronic hepatitis B virus carriers

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