Goals: The study is to evaluate the efficacy and long-term safety of telbivudine (LdT) usage for hepatitis B surface antigen (HBsAg) positive pregnant women with high viral load. Background: The efficacy and safety of LdT during pregnancy were not assessed from a long-term perspective. Study: HBsAg-positive pregnant women were enrolled and grouped according to antiviral initiation time. Group A (n=100) and group B (n=100) were treated with LdT initiated in the second or third trimester. Group C (n=90) received no antiviral treatment. The efficacy and safety of LdT treatment were compared and infants were followed-up at 1, 5, and 10 years. Denver developmental screening test was conducted at 5 years. Results: Viral loads before delivery in LdT-treated groups were lower than that in group C and group A was lower than that in group B (P<0.001). No infants in LdT-treated groups were infected whereas 8.8% (8/90) infants in group C had positive HBsAg (χ2=23.20, P<0.001). All LdT-treated mothers were well tolerated and no LdT-related adverse events in infants were reported. Part of the physical growth index of infants was higher than Chinese standard values (SV) and showed significant differences. In groups A and B, the developmental screening test qualified rate of 100% (48/48) and 97.96% (48/49) showed no significant difference compared with 92% in normal Chinese children (χ2=5.72, P=0.06). Conclusions: Treatment initiated during the second trimester could strengthen the success of mother-to-child transmission blockage. LdT treatment during pregnancy is safe for both mothers and infants in the long term.

Aim: To investigate the immune status of Chinese chronic hepatitis B (CHB) pregnant women and their clinical characteristics.Methods: About 1544 CHB pregnant women without antiviral therapy from 2013 to 2018 were selected from the hospital records. The definition of immune status is based on American Association for the Study of Liver Diseases (AASLD) 2018 Hepatitis B Guidance, and those who did not meet any criteria of the immune status were referred to in the gray zones (GZ).Results: There were 284 patients in the immune-tolerance phase, 72 patients in the HBeAg-positive immune active phase, 553 patients in the inactive phase, 61 patients in the HBeAg-negative immune active phase. Of note, 574 (37.18%) patients did not fit into any of the above phases were defined as the GZ. Patients with elevated ALT had a higher rate of intrahepatic cholestasis of pregnancy (ICP). Mother to child HBV transmission was rare (only two cases) and occurred in mothers in the immune-tolerant phase.Conclusions: Our data showed that more than one-third of CHB pregnant women were classified into the GZ. In standard stages, advanced age is associated with HBeAg-negative and a higher cesarean rate in the inactive phase. The incidence of ICP was higher in immune active phases, including GB and GD. The probability of mother-to-child transmission in gray zones is low.

乙型肝炎病毒(HBV)感染是造成肝硬化、肝癌的主要危险因素之一,HBV感染的自然病史主要取决于病毒和宿主的相互作用.我国育龄女性中约8％为慢性HBV感染者,女性在妊娠期免疫系统处于抑制状态,产后激素的急剧变化和免疫抑制状态的解除,可能会影响HBV感染的自然病史进程.现有的文献表明,妊娠会使免疫耐受期孕妇妊娠期或产后发生肝炎活动进入免疫清除期;免疫清除期孕妇产后继续抗病毒治疗可以提高乙型肝炎e抗原(HBeAg)的阴转和血清学转换率;免疫控制期的孕妇妊娠期可能会发生HBV再激活,进入再活动期.临床上,需要对HBV感染孕妇进行定期监测,必要时给予干预治疗,促进妊娠期间HBV感染自然病史的良好转归.

Background The relationship of maternal HBeAg and infants’ response to hepatitis B vaccine remains controversial. This study aims to observe the dynamic changes in infant birth HBV markers and study the time-varying effects of maternal HBeAg on vaccination response of infants born to women with chronic HBV infection. Methods 3163 infants born to HBsAg positive mothers including 1737 with maternal HBeAg positive in group A and 1426 negative in group B were enrolled eventually. Demographic information and laboratory tests were collected at birth, 7-12th and 24th month. The dynamic changes of infant HBV markers and HBsAb titers at different time points were compared between the two groups. Results The infant HBV markers at birth displayed different modes. During the follow-up, we observed a significant downward trend in the positive rates of HBsAg, HBeAg, HBeAb and HBcAb. The HBsAg of two groups switched to negative at 7–12 months and HBeAg in Group A became negative at 24 months. The HBsAb titers of the infants in the two groups were 576.91(192.8–1000.0) vs 719.67(208.1–1000.0) at 7–12 months (Z = -3.049, P = 0.002) and 783.5(227.8–1000.0) vs 891.4(234.0–1000.0) at 24 months (Z = -0.853, P = 0.394). High HBV DNA viral load (OR 1.260, 95% CI 1.139–1.395, P < 0.001) and maternal HBeAg level (OR 1.003, 95% CI 1.002–1.003, P < 0.001) were associated with the higher HBeAg positive rate of infants. Conclusions Maternal HBeAg did affect the infants’ immune response to vaccination and reduce the anti-response at 7-12th month temporarily, but these influences were negligible by 24th months after birth, which proved that the maternal HBeAg would not induce immune tolerance of infants from a long-term perspective.

尽管有包括疫苗接种在内的有效预防措施,HBV 感染至今仍是世界范围内尤其是亚太地区的重大公共卫生问题.乙型肝炎相关疾病的负担主要来源于围生期母婴垂直传播或婴幼儿时期水平传播.婴幼儿期HBV 感染常迁延为慢性,因此采取适当措施预防母婴垂直传播至关重要.本指南[1]旨在为医务工作者提供乙型肝炎孕妇妊娠期和产后管理的首选方案,以及婴儿出生时的最佳处理措施和随访管理方法.本指南仅提供适用于大多数患者的一般建议,对于特殊患者请临床医生根据具体情况酌情处理.指南中证据等级和推荐强度采用GRADE 系统评价方法(表1).

目的 研究非酒精性脂肪肝(NAFLD)对乙型病毒性肝炎孕妇妊娠结局和孕期抗病毒治疗效果的影响,为完善该群体孕期和围生期管理提供更多可靠证据.方法 选取2020年1月1日至2021年12月31日在南京市第二医院产检并分娩的乙型病毒性肝炎孕妇,根据有无NAFLD分为NAFLD组(35例)和non-NAFLD组(156例),通过倾向性得分匹配进行配对,对不良妊娠结局(25对患者)、抗病毒治疗效果(12对患者)进行组间差异比较.结果 与non-NAFLD组相比,NAFLD组发生母儿不良结局的风险增加(均P<0.05),对比两组不良妊娠结局的评分发现差异有统计学意义(P=0.01).妊娠期及产后42d NAFLD组的血小板计数均高于non-NAFLD组,平均血小板体积NAFLD组低于non-NAFLD组.对两组中高病毒载量乙型肝炎孕妇妊娠中期启动抗病毒治疗的效果进行对比,发现基线、抗病毒治疗4周及8周乙型肝炎病毒DNA的水平差异均无统计学意义.结论 NAFLD会增加乙型肝炎孕妇母儿不良结局发生风险,对高病毒载量乙肝孕妇妊娠中期抗病毒治疗效果无明显影响.血小板相关指标可能是合并NAFLD乙肝孕妇潜在的疾病预后预测指标.