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Title: [Impact of cessation of antiviral therapy at delivery on postpartum liver function in mothers with chronic hepatitis B virus infection].
Author: Guo HJ, Gao YF, Liu HY, He HT, Huang MT, Cai DC, Liao DD, Li JN, Yin XR, Liu ZH, Hu J.
Journal: Zhonghua Gan Zang Bing Za Zhi; 2019 Feb 20; 27(2):112-117. PubMed ID: 30818915.
Abstract:
Objective: To investigate the impact of immediate cessation of antiviral therapy on postpartum liver function and the factors influencing postpartum abnormality in mothers with chronic hepatitis B virus infection. Methods: A retrospective cohort study was conducted. One hundred eighty-eight pregnant women with HBV DNA level > 2×106 IU/ml were enrolled from June 2014 to June 2018. Demographic information and clinical data of liver function and HBV DNA load during gravidity, intrapartum and postpartum period were collected. According to the antiviral treatment recommendations during pregnancy, the women were divided into three groups, namely, tenofovir (TDF), telbivudine (LdT) and control group. Liver function abnormalities among the three groups were compared within 6 months after delivery, and the factors influencing abnormal liver function were analyzed by unconditional logistic regression. Results: Of the 188 cases, 72 cases were in the TDF group, 80 cases in the LdT group, and 36 cases in the control group. Pregnant women in the TDF and LdT groups received oral TDF (300 mg/d) and LdT (600 mg/d) from 28 ± 4 weeks of gestation till delivery. Among the 188 patients, 30 (16.0%) had abnormal postpartum liver function abnormality. The incidence of postpartum liver function abnormality [alanine aminotransferase (ALT) > 2 × upper limit of normal (ULN)] in the TDF, LdT, and control groups was 19.4%, 12.5%, and 16.7%, respectively. The postpartum peak levels of ALT (median, range) in the three groups were 34.5 (12.0-946.0) U/L, 37.5 (12.0-733.8) U/L, and 39.0 (7.0-513.0) U/L, respectively. There was no significant difference between the two indexes among the three groups (P > 0.05). There was no statistically significant difference in the degree of postpartum liver function abnormalities between the three groups (P = 0.944). Most of the liver function abnormalities were mild to moderate (2 × ULN≤ALT < 10 × ULN), and usually resolved spontaneously or by treatment. Univariate and multivariate analysis showed that baseline ALT level during pregnancy was an independent factor associated with postpartum liver function abnormality (OR = 1.031, CI 95%: 1.005-1.058; χ(2) = 5.340, P = 0.021), whereas age, antiviral therapy, HBeAg-positivity, baseline HBV DNA levels, gravidity, parity, preterm delivery and delivery mode were not significantly associated with postpartum liver function abnormality. Conclusion: Cessation of antiviral therapy after delivery did not significantly increase the risk of postpartum liver function abnormality in pregnant women with chronic HBV infection. The ALT level during pregnancy is a factor influencing postpartum liver function 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 DNA > 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= 1.031, 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。.

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