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| HBV感染免疫耐受期孕妇分娩前后
临床指标及细胞因子水平变化特征 |
| Changes of clinical parameters and cytokine levels in pregnant women infectedwith HBVin immune-tolerant phase before and after delivery |
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| DOI：10.3969/j.issn.1007-8134.2022.05.004 |
| 中文关键词: 免疫耐受期 HBV 母婴传播 孕妇 分娩前 分娩后 ALT 细胞因子 |
| 英文关键词: immune-tolerant phase HBV mother-infant transmit pregnant women ante partum post partum ALT cytokine |
| 基金项目:青海省重点研发与转化计划（2017-SF-159）；青海省高端创新人才千人计划（2016年）；北京市医院管理中心重点医学专业发展计划（扬帆计划）（ZYLX202125）；首都卫生发展科研专项项目（首发2020-1-2181） |
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| 中文摘要: |
| [摘要] 目的 分析HBV感染免疫耐受期孕妇分娩前后临床指标及细胞因子水平的变化规律，比较分娩后不同ALT水平组孕妇血清细胞因子水平差异。方法 选择2015年1月—2017年12月就诊于首都医科大学附属北京佑安医院的HBV感染免疫耐受期孕妇52例，妊娠28周给予替比夫定（telbivudine, LdT）抗病毒干预，分别于LdT干预前（基线）、分娩前（2周）及分娩后（6周）进行生化、血清学及病毒学检测，同步留取相应时间点外周血标本进行细胞因子检测，并分析分娩前后临床指标及细胞因子水平的变化特征。结果 52例患者分娩后6周ALT水平均值明显高于LdT干预前和分娩前，其中ALT≥2倍正常值上限（upper limit of normal, ULN）者达28.8%（15/52例）；与LdT干预前相比，分娩前HBV DNA水平显著下降，平均降幅达（3.68±0.79） lg IU/ml；HBsAg和HBeAg水平在分娩前后无明显变化。与分娩后ALT＜2倍ULN组相比，ALT≥2倍ULN组的IFN-γ水平在LdT干预前呈低水平表达，分娩后呈高水平表达，差异均有统计学意义（Z=2.284，P=0.022；Z=2.223，P=0.026）；2组间IL-2、IL-4、IL-6、IL-10、TNF-α在LdT干预前、分娩前及分娩后均无明显差异。结论 HBV感染免疫耐受期孕妇分娩后部分患者ALT明显升高，结合分娩前后细胞因子的动态变化，提示分娩后可能出现免疫功能增强并打破机体对HBV的免疫耐受，这或许有利于分娩后的抗病毒治疗，但仍须要进一步深入的研究。 |
| 英文摘要: |
| [Abstract] Objective To analyze the changes of clinical parameters and cytokine levels in pregnant women with HBV infection in immune-tolerant phase before and after delivery and compare the differences of cytokine levels between different ALT levels after delivery. Methods Fifty-two pregnant women with HBV infected in immune-tolerant phase who admitted to Beijing Youan Hospital, Capital Medical University from January 2015 to December 2017 were enrolled. All pregnant women received antiviral treatment with Telbivudine (LdT) at 28 weeks of gestation. Biochemical, serological, and virological tests were performed before LdT intervention(baseline), ante partum(2 weeks) and post partum(6 weeks). Peripheral blood samples at the same time points were collected for cytokine level detection. The clinical parameters and cytokine levels before and after delivery were analyzed. Results The mean level of ALT at 6 weeks after delivery was significantly higher than that before LdT intervention and ante partum and 15 pregnant women (28.8%) had ALT≥2×upper limit of normal (ULN) at 6 weeks after delivery. HBV DNA level decreased significantly in ante partum than that before LdT treatment with an average decrease of (3.68±0.79) IgIU/ml. HBsAg and HBeAg level had no significant change before and after delivery. Compared with patients with ALT＜ 2×ULN after delivery, the level of IFN-γ was lower before LdT intervention and higher after delivery and the difference was statistically significant（Z=2.284, P=0.022; Z=2.223, P=0.026）in patients with ALT≥2×ULN. The levels of IL-2, IL-4, IL-6, IL-10 and TNF-α were not significantly different before LdT treatment, ante partum and after deliverybetween the 2 groups. Conclusions The ALT level was significantly increased after delivery in some pregnant patients with HBV infection in immune-tolerant phase. Combined with the dynamic changes of cytokine levels before and after delivery, it is suggested that the immune function may be enhanced after delivery and the immune tolerance to HBV may be broken, which may be beneficial to antiviral treatment after delivery, but further research is needed. |
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