摘要
目的探讨慢性乙型肝炎病毒(hepatitis B virus,HBV)感染孕妇替比夫定治疗前后血清谷丙转氨酶(alanine aminotransferase,ALT)、总胆红素(total bilirubin,TBil)、HBV DNA、HBV标志物及细胞因子水平变化。方法选取延安市人民医院2014年5月至2017年5月收治的60例慢性HBV感染孕妇为研究对象,根据孕妇ALT水平将其分为免疫耐受组(39例)和免疫活化组(21例),所有孕妇妊娠中晚期均给予600 mg/d替比夫定进行治疗,常规检测并分析孕妇治疗前后血清ALT、HBV DNA、TBil、HBV标志物及细胞因子等水平的变化情况。结果两组孕妇分娩前均未出现乙型肝炎e抗原(hepatitis Be antigen,HBe Ag)血清学转换,且治疗前后两组孕妇的ALT和TBil水平均无明显变化(P> 0. 05);两组孕妇治疗后的HBV DNA水平均低于治疗前(P<0. 05)。两组孕妇治疗前与分娩前的干扰素-γ(interferonγ,IFN-γ)、白细胞介素-2(interleukin-2,IL-2)表达水平均高于健康人群,IL-6和IL-4表达水平则低于健康人群。两组孕妇治疗前和分娩前的IL-2、IFN-γ、IL-4、IL-6等各项细胞因子水平差异均无统计学意义(P> 0. 05)。两组孕妇体内的ALT水平和IL-2、IFN-γ水平均无明显相关关系(P> 0. 05)。结论慢性HBV感染孕妇在妊娠中晚期血清辅助性T细胞(helper T cell,Th) 2型细胞因子表达水平较低,Th 1型细胞因子表达水平较高;短期的替比夫定治疗对于慢性HBV感染孕妇的Th 1/Th 2平衡影响较小。
Objective To investigate serum levels changes of alanine aminotransferase （ALT）, total bilirubin （TBil）, hepatitis B virus （HBV） DNA and its markers, cytokines in pregnant women with chronic HBV infection before and ＂after treatment of telbivudine. Methods 60 patients with chronic HBV infection treated in Yah＇an People＇s Hospital from May 2014 to May 2017 were selected, according to the patients＇level of ALT, they were divided into the immune tolerance group （39 cases） and immune activation group （21 cases）. All pregnant women were given telbivudine 600 mg/d during the second and third trimester of pregnancy. The changes of serum ALT, HBV DNA, TBil, HBV markers and cytokines were detected and analyzed routinely before and after treatment. Results Serum conversion of Hepatitis B e antigen （HBeAg） did not appear before delivery in both groups, and the levels of ALT and TBil in both groups had no significant change before and after treatment （P 〉 0.05 ） ; HBV DNA levels after treatment in both groups were lower than before treatment （P 〈 0. 05）. The levels of interferon - γ （ IFN - γ） and interleukin - 2 （ IL - 2） before treatment and before delivery in both groups were significantly higher than those in healthy people, while the levels of IL -6 and IL -4 were lower than in healthy people. The levels of IL - 2, IFN - γ, IL - 4, IL - 6 and other cytokines before treatment and before delivery in the two groups were not significantly different （ P 〉 0.05 ）. There was no significant correlation between ALT levels and IL - 2 and IFN - γ levels in both groups （P 〉 0.05）. Conclusion Pregnant women with chronic HBV infection have lower levels of serum helper T cell type 2 eytokines and higher levels of Th 1 eytokines in the second trimester of pregnancy. Short - term telbivudine treatment has less effect on Th 1/Th 2 balance in pregnant women with chronic HBV infection.
作者
张政梅
梁娜
ZHANG Zheng-mei;LIANG Na(Department of Obstetrics,Yan＇an Peoples Hospital,Yan＇an Shaanxi 716000,P.R.China)
出处
《中国计划生育和妇产科》
2018年第10期50-53,共4页
Chinese Journal of Family Planning & Gynecotokology
