切换至 "中华医学电子期刊资源库"

中华产科急救电子杂志 ›› 2017, Vol. 06 ›› Issue (02) : 92 -97. doi: 10.3877/cma.j.issn.2095-3259.2017.02.007

所属专题: 文献

专家论坛

妊娠期重症肝炎的防治
韩国荣1,(), 许传露2   
  1. 1. 210003 南京市,东南大学附属第二医院 南京市第二医院妇产科
    2. 200400 上海,同济大学附属上海市第一妇婴保健院妇产科
  • 收稿日期:2017-01-30 出版日期:2017-05-18
  • 通信作者: 韩国荣
  • 基金资助:
    国家自然基金面上项目(81370583); 江苏省临床重大专项(BL2014006)

Prevention and treatment of severe hepatitis in pregnancy

Guorong Han1(), Chuanlu Xu2   

  • Received:2017-01-30 Published:2017-05-18
  • Corresponding author: Guorong Han
引用本文:

韩国荣, 许传露. 妊娠期重症肝炎的防治[J]. 中华产科急救电子杂志, 2017, 06(02): 92-97.

Guorong Han, Chuanlu Xu. Prevention and treatment of severe hepatitis in pregnancy[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2017, 06(02): 92-97.

重症肝炎是指肝细胞在短期内大量坏死或严重变性所致的肝衰竭。该病特点为发展迅速、病情严重、并发症多、病死率高。妊娠合并重症肝炎的治疗强调早期识别、及时转诊、严密监测、孕期抗病毒、多学科协作等综合治疗,同时积极防治并发症,适时终止妊娠,以降低孕产妇与围产儿的病死率。

Severe hepatitis refers that lots of liver cells occur necrosis or serious degeneration in a short term, which cause liver failure. The characteristics of severe hepatitis are rapid aggressive clinical course, severe condition, many complications and high fatality. To reduce maternal and perinatal mortality, the treatments of sever hepatitis not only emphasize on early recognition, timely referral, close monitoring, antiviral treatment and interdisciplinary cooperation, but also include prevention the complications actively and terminating pregnancy timely.

表1 妊娠合并重症肝炎的鉴别诊断[9]
[1]
Lefkowitch JH. The pathology of acute liver failure[J]. Adv Anat Pathol, 2016, 23(3):144-158.
[2]
Li XM, Ma L, Yang YB, et al. Clinical characteristics of fulminant hepatitis in pregnancy[J]. World J Gastroenterol, 2005, 11(29):4600-4603.
[3]
Jin H, Zhao Y, Zhang X, et al. Case-fatality risk of pregnant women with acute viral hepatitis type E: a systematic review and meta-analysis[J]. Epidemiol Infect, 2016, 144(10):2098-2106.
[4]
Khuroo MS, Khuroo MS, Khuroo NS. Discovery, global impact, control and cure[J]. World J Gastroenterol, 2016, 22(31):7030-7045.
[5]
Licata A, Ingrassia D, Serruto A, et al. Clinical course and management of acute and chronic viral hepatitis during pregnancy[J]. J Viral Hepat, 2015, 22(6):515-523.
[6]
Halliday J, Lokan J, Angus PW, et al. A case of fulminant hepatic failure in pregnancy[J]. Hepatology, 2010, 51(1):341-342.
[7]
李小毛. 妊娠合并重型肝炎的治疗现状及进展[J]. 新医学,2005, 36(2):65-67.
[8]
马洁,刘建. 妊娠合并重症肝炎的诊治进展[J]. 医学信息,2014, 27(4):495-496.
[9]
郝秀兰,侯红瑛. 关于妊娠合并重症肝炎[J/CD]. 中华产科急救电子杂志,2012, 1(1):14-16.
[10]
尹玉竹,周瑾. 妊娠合并肝衰竭的产科处理[J/CD]. 中华产科急救电子杂志,2014, 3(3):172-175.
[11]
黄琳琳,刘建. 妊娠合并重症肝炎治疗进展[J]. 中外医疗,2015, (11):194-196.
[12]
McCormick PA, Donnelly C. Management of hepatorenal syndrome[J]. Pharmacol Ther, 2008, 119(1):1-6.
[13]
Li M, Sun J, Li J, et al. Clinical observation on the treatment of acute liver failure by combined non-biological artificial liver[J]. Exp Ther Med, 2016, 12(6):3873-3876.
[14]
Komura T, Taniguchi T, Sakai Y, et al. Efficacy of continuous plasma diafiltration therapy in critical patients with acute liver failure[J]. J Gastroenterol Hepatol, 2014, 29(4):782-786.
[15]
Wu DB, Chen EQ, Bai L, et al. Propylthiouracil-induced liver failure and artificial liver support systems: a case report and review of the literature[J]. Ther Clin Risk Manag, 2017, 13:65-68.
[16]
Mendizabal M, Rowe C, Piñero F, et al. Successful orthotopic liver transplantation and delayed delivery of a healthy newborn in a woman with fulminant hepatic failure during the second trimester of pregnancy[J]. Ann Hepatol, 2014, 13(2):288-292.
[17]
唐晖,傅斌生,易慧敏,等. 肝移植治疗妊娠期合并急性肝衰竭2例并文献复习[J]. 器官移植,2015, 6(6):388-391.
[18]
Mendizabal M, Silva MO. Liver transplantation in acute liver failure: A challenging scenario[J]. World J Gastroenterol, 2016, 22(4):1523-1531.
[19]
Fukumitsu K, Yagi H, Soto-Gutierrez A.Bioengineering in organ transplantation: targeting the liver[J]. Transplant Proc, 2011,43(6):2137-2138.
[20]
Pan CQ, Lee HM. Antiviral therapy for chronic hepatitis B in pregnancy[J]. Semin Liver Dis, 2013, 33(2):138-146.
[21]
Pan CQ, Han GR, Jiang HX, et al. Telbivudine prevents vertical transmission from HBeAg-positive women with chronic hepatitis B[J]. Clin Gastroenterol Hepatol, 2012, 10(5):520-526.
[22]
Han GR, Jiang HX, Wang CM, et al. Long-term safety and efficacy of telbivudine in infants born to mothers treated during the second or third trimesters of pregnancy[J]. J Viral Hepat, 2017, 24(2):514-521.
[23]
Han GR, Cao MK, Zhao W, et al. A prospective and open-label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus infection[J]. J Hepatol, 2011, 55(6):1215-1221.
[24]
Han GR, Jiang HX, Yue X, et al. Efficacy and safety of telbivudine treatment: an open-label, prospective study in pregnant women for the prevention of perinatal transmission of hepatitis B virus infection[J]. J Viral Hepat, 2015, 22(9):754-762.
[25]
Xu WM, Cui YT, Wang L, et al. Lamivudine in late pregnancy to prevent perinatal transmission of hepatitis B virus infection: a multicentre, randomized, double-blind, placebo-controlled study[J]. J Viral Hepat, 2009, 16(2):94-103.
[26]
Tran TT. Management of hepatitis B in pregnancy: weighing the options[J]. Cleve Clin J Med, 2009, 76(Suppl 3):S25-S29.
[27]
Pan CQ, Duan Z, Dai E, et al. Tenofovir to prevent hepatitis b transmission in mothers with high viral load[J]. N Engl J Med, 2016, 374(24):2324-2334.
[28]
Chang ML, Liaw YF. Hepatitis B flares in chronic hepatitis B: pathogenesis, natural course, and management[J]. J Hepatol, 2014, 61(6):1407-1417.
[29]
Han GR, Xu CL, Zhao W, et al. Management of chronic hepatitis B in pregnancy[J]. World J Gastroenterol, 2012, 18(33):4517-4521.
[30]
韩国荣,丁祎. 慢性乙型肝炎育龄妇女及孕妇的抗病毒治疗指征与时机的选择[J]. 中华肝脏病杂志,2015, 23(11):806-809.
[31]
Chen H, Yuan L, Tan J, et al. Severe liver disease in pregnancy[J]. Int J Gynaecol Obstet, 2008, 101(3):277-280.
[32]
李小毛. 晚期妊娠合并重型肝炎产科处理的若干问题[J].广东医学,2007, 28(5):683-684.
[33]
Deng L, Li X, Shi Z, et al. Maternal and perinatal outcome in cases of fulminant viral hepatitis in late pregnancy[J]. Int J Gynaecol Obstet, 2012, 119(2):145-148.
[34]
Labrique AB, Sikder SS, Krain LJ, et al. Hepatitis E, a vaccine preventable cause of maternal deaths[J]. Emerg Infect Dis, 2012, 18(9):1401-1404.
[35]
Kumar M, Singh T, Sinha S. Chronic hepatitis B virus infection and pregnancy[J]. J Clin Exp Hepatol, 2012, 2(4):366-381.
[1] 卢天祺, 张巍, 周康, 毕士玉, 张羽, 杨秀华. 血流向量成像技术在不同Child-Pugh分级乙肝患者左心功能评价中的价值[J]. 中华医学超声杂志(电子版), 2024, 21(04): 352-360.
[2] 张雨, 杨松. 世界卫生组织《慢性乙型肝炎预防、诊断、关怀及治疗指南(2024年版)》解读[J]. 中华实验和临床感染病杂志(电子版), 2024, 18(03): 129-134.
[3] 李敏, 杨世英, 高晓琴, 周丹, 唐筱, 张立婷. 维生素A与慢性肝病相关性研究进展[J]. 中华实验和临床感染病杂志(电子版), 2024, 18(02): 65-70.
[4] 邓万玉, 陈富, 许磊波. 肝硬化与非肝硬化乙肝相关性肝癌患者术后无复发生存比较及其影响因素分析[J]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 670-674.
[5] 刘建勇, 杨芳, 吕立志, 江艺, 蔡秋程. 肝移植治疗Ⅳ级肝昏迷疗效及其影响因素分析[J]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 344-349.
[6] 唐诗, 薛传优, 叶兴, 张鸿举, 戴瑞. 急性病毒性肝炎患者血脂、血糖、蛋白、尿酸变化特点及其与预后的关联[J]. 中华消化病与影像杂志(电子版), 2024, 14(05): 396-399.
[7] 胡静, 杨秀锦, 侯志云. HBV感染患者外周血ISGs表达水平变化及其与干扰素治疗疗效的关系[J]. 中华消化病与影像杂志(电子版), 2024, 14(04): 343-347.
[8] 江浩, 余宏圣, 杨碧兰, 阿布都克尤木·斯马依, 吴斌, 杨逸冬. 基于列线图模型对慢性乙型肝炎合并肝脏脂肪变性患者并发晚期肝纤维化的临床预测[J]. 中华消化病与影像杂志(电子版), 2024, 14(02): 114-120.
[9] 王秀, 王义国. 益生菌联合恩替卡韦治疗乙型肝炎肝硬化临床疗效的meta分析[J]. 中华消化病与影像杂志(电子版), 2024, 14(02): 164-171.
[10] 黄圣楷, 许斌, 苏健, 孙龙. 海南省2010~2020年乙型肝炎流行趋势的时间序列分析及预测[J]. 中华临床医师杂志(电子版), 2024, 18(06): 555-561.
[11] 王星, 陈园, 热孜万古丽·乌斯曼, 郭艳英. T2DM、Obesity、NASH、PCOS共同致病因素相关的分子机制[J]. 中华临床医师杂志(电子版), 2024, 18(05): 481-490.
[12] 邵小桐, 张琦昱, 马惠军, 徐蕾, 赵晓慧, 牛洪涛. 功能磁共振对经颈静脉肝内门体分流术术前轻微肝性脑病诊断的研究进展[J]. 中华介入放射学电子杂志, 2024, 12(02): 171-175.
[13] 李玛, 闫凌, 席云, 李尚霞, 朱冬林. HBV RNA用于监测慢性乙型肝炎患者临床治愈的研究和应用[J]. 中华临床实验室管理电子杂志, 2024, 12(02): 70-74.
[14] 刘春林, 刘畅, 赵东岩, 李端萍, 刘建梅, 罗秋林. 利用室内质控与能力验证数据评定HBV DNA和HCV RNA测量不确定度[J]. 中华临床实验室管理电子杂志, 2024, 12(02): 91-96.
[15] 郭楠, 徐学俊. 富马酸替诺福韦二吡呋酯在慢性乙型肝炎患者中诱导的范科尼综合征并低磷软骨病一例[J]. 中华诊断学电子杂志, 2024, 12(03): 173-177.
阅读次数
全文


摘要