关键词: 慢性乙型肝炎病毒携带状态, 妊娠, 抗病毒, HBeAg滴度, 肝炎活动

Abstract:

Objective To study the related factors of postpartum discontinuation of mother infant antiviralblocking leading to hepatitis activity among pregnant women with chronic HBV. Methods A prospective analysisof pregnant women with HBV infections in our hospital and the Affiliated Hospital of Nantong University fromJanuary 2016 to January 2020 was conducted. Totally 93 pregnant women with chronic HBV that met the criteriawere selected as the research subjects，and antiviral drugs were given during pregnancy，which should be stoppedimmediately or 1 ~ 3 months after delivery. Liver function，HBV⁃ M and HBV⁃DNA titers were followed up beforeantiviral treatment，when antiviral drug was stopped，and 1 month，3 and 6 months after antiviral treatment discon⁃tinuation，to find out the status of hepatitis activity and possible related factors after antiviral treatment discontinua⁃tion. Results Thirty⁃three patients（35.48%）had hepatitis activity within six months after antiviral treatmentdiscontinuation. According to the liver function 6 months after antiviral treatment discontinuation，the observationobjects were divided into hepatitis activity group and hepatitis⁃free activity group. Comparison of related itemsbetween the two groups found that previous antiviral treatment，combined with autoimmune diseases，second preg⁃nancy，antiviral gestational weeks，antiviral drug（telbivudine and tenofovir），discontinuation of antiviral drugs2 ~3 months postpartum，antiviral treatment time，and HBeAg titers when antiviral treatment discontinuation werestatistically different（P＜0.05）. Multivariate logistic regression analysis found that HBeAg titer were independentlycorrelated with hepatitis activity when antiviral drugs were discontinued（OR = 3.253，P = 0.025，95%CI：1.225 ~8.163）. ROC curve analysis was used and showed that the area under the curve was 0.733；the maximum Youdenindex 0.561；the optimal critical value 258 S/CO，and the corresponding sensitivity and specificity were 72.73% and 83.33% respectively（P＜0.001，95%CI：0.632 ~ 0.820）. Conclusion Tenofovir can be used in pregnantwomen with chronic HBV in the second and third trimester of pregnancy for mother infant antiviral blocking.Dynamic monitoring of HBeAg titer could provide clinical reference for the discontinuation of antiviral.

Key words: chronic HBV carrier status, pregnancy, antiviral, HBeAg titer, hepatitis activity