| Objective: At present,the use of nucleoside analogues(NAs)antiviral drugs in the middle or late pregnancy to improve therate of mother-to-childhepatitis B virus(HBV)interruptionhas been recommended by many national guidelines.However,compared with patients with chronic hepatitis B,the duration of this kind of use is short.Will it cause recurrence of hepatitis B and deterioration of the disease after stopping the drugs?Therefore,our study aimed to observe the clinical characteristics in postpartum of high hepatitis B virus(HBV)load pregnant women taking NAs in the middle or late pregnancy,and to analysis of influencing factors of alanine transaminase(ALT)abnormalities in postpartum,then to provide a basis for better clinical application of NAs in mother-tochild transmission of hepatitis B virus.Methods: 166 cases of high hepatitis B virus load group(HHBV)and 49 cases of low hepatitis B virus load(LHBV)were collected.The HHBV group was divided into 137 cases of antiviral group with high hepatitis B virus load(AHHBV)and non-antiviral group with high hepatitis B virus load(NAHHBV)according to whether NAs were added in the middle or late pregnancy by the patient himselfchoice.The AHHBV group discontinued NAs at 0 weeks postpartum.Each group was divided into ALT normal group and abnormal group according to whether ALT abnormality occurred within 24 weeks after delivery.Liver biochemistry and hepatitis B markers were monitored at the beginning of antiviral therapy,withdrawal of drugs,4,12 and 24 weeks after delivery in AHHBV group when NAHHBV and LHBV groups monitor these during the middle or late pregnancy and at 4,12 and 24 weeks after delivery.The clinical significance was analyzed by comparing each groups.Logistic regression analysis was performed on the factors in the AHHBV group that may affect postpartum ALT abnormalities.Results:1.Comparison of AHHBV and NAHHBV groups: There was no significant difference in ALT abnormal rate between the two groups within 24 weeks after delivery(P>0.05).The new rates of ALT abnormalities at 12 weeks postpartum in AHHBV group was significant lower than that in NAHHBV group(P<0.05)when there was no significant difference between the two groups at 4 and 24 weeks postpartum(P>0.05;P>0.05);The ALT abnormal level in the AHHBV group was significant lower than that in the NAHHBV group at 4 weeks postpartum(P<0.05),but the ALT abnormal level in the AHHBV group increased with time,while the ALT abnormal level in the NAHHBV group showed a downward trend;Re-antiviral rate was 9/51(17.6%)in AHHBV group and 1/13(7.7%)in NAHHBV group in postpartum ALT abnormalities2.Comparison of NAHHBV and LHBV groups: The abnormal rate of ALT in the NAHHBV group was significant higher than that in the LHBVgroup within 24 weeks postpartum(P<0.05).3.Comparison of AHHBV and LHBV groups :After a short-term antiviral treatment,the HBV DNA load in AHHBV group was still higher than that in LHBV group at the same time(P<0.05).The abnormal ALT rate in AHHBV group was significant higher than that in LHBV group within 24 weeks after delivery(P<0.05).4.Logistic regression analysis was performed on the factors that may affect ALT abnormalities in the AHHBV group.The results showed that HBV DNA load at withdrawal was a risk factor for postpartum ALT abnormalities(P<0.05,OR=1.734).Conclusion:1.Short-term antiviral intervention in the middle or late pregnancy is not completely safe,need to strengthen follow-up after stopping the drug,longer-term observation.2.Regardless of whether it is antiviral,the prenatal HBV DNA load may be related to the abnormal postpartum ALT.3.Analysis of AHHBV group that may affect the post-natal ALT abnormalities found in a variety of factors,HBV DNA load at the time of withdrawal is a risk factor for postpartum ALT abnormalities. |
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