Abstract:Achieving clinical cure can significantly improve long-term adverse outcomes in patients and has become the ideal treatment goal for chronic hepatitis B (CHB) . However, this goal is only realized in a minority of patients with advantageous baseline characteristics. Clinical studies indicate that the postpartum relief of immunosuppression in women with chronic hepatitis B virus (HBV) infection may increase the chance of HBV clearance, suggesting this group could be a potential advantaged population for hepatitis B clinical cure. Therefore, identifying favorable candidate subgroups among pregnant women with chronic HBV infection, selecting the appropriate timing for antiviral therapy, and choosing optimal treatment regimens are crucial for further improving the cure rate. This article reviews literature from databases such as CNKI and PubMed (2010-2025) on maternal immune characteristics and antiviral therapy, summarizing postpartum immune changes in chronic HBV-infected mothers, the efficacy and adverse effects of different antiviral regimens, and key factors influencing clinical cure, aiming to provide a basis for developing individualized treatment strategies CHB; patients and enhancing the clinical cure rate in practice.
陈威, 刘寿荣. 慢性乙型肝炎病毒感染女性产后免疫状态变化及临床治愈策略研究进展[J]. 预防医学, 2026, 38(3): 284-290.
CHEN Wei, LIU Shourong. Research progress on changes of postpartum immune status and clinical cure strategies among women with chronic hepatitis B virus infection. Preventive Medicine, 2026, 38(3): 284-290.
[1] KAUR S P,TALAT A,KARIMI-SARI H,et al.Hepatocellular carcinoma in hepatitis B virus-infected patients and the role of hepatitis B surface antigen(HBsAg)[J/OL].J Clin Med,2022,11(4)[2026-02-05].https://doi.org/10.3390/jcm11041126. [2] ZHOU K L,CONTAG C,WHITAKER E,et al.Spontaneous loss of surface antigen among adults living with chronic hepatitis B virus infection:a systematic review and pooled meta-analyses[J].Lancet Gastroenterol Hepatol,2019,4(3):227-238. [3] HSU Y C,JUN D W,PENG C Y,et al.Effectiveness of entecavir vs tenofovir disoproxil fumarate for functional cure of chronic hepatitis B in an international cohort[J].Hepatol Int,2022,16(6):1297-1307. [4] ZHANG P X,TANG Q Q,ZHU J,et al.Predictive models for functional cure in patients with CHB receiving PEG-IFN therapy based on HBsAg quantification through meta-analysis[J].Hepatol Int,2024,18(4):1110-1121. [5] 蒋素贞,王竞州,陈香梅,等.宿主HBV特异性细胞免疫或是慢性乙型肝炎患者核苷(酸)类药物停药不复发和HBsAg清除的决定因素[J].肝脏,2025,30(7):889-892. [6] 高林,姜倩倩,鲁凤民.血清HBsAg持续低水平与慢性乙型肝炎患者临床治愈相关进展[J].临床内科杂志,2023,40(12):798-801. [7] YOU R R,ZHANG Q R,YU Y Q,et al.Comparative efficacy of IFN and Nuc therapy regarding HBsAg loss in chronic hepatitis B patients[C]//The Liver Meeting2025.Alexandria:AASLD,2025:Abstract-OP0334. [8] TANG Q,WANG C R,LI H,et al.PgRNA closely correlates to cytokine profile in HBeAg-positive pregnant women undergoing prophylactic antiviral intervention[J/OL].Front Immunol,2024,15[2026-02-05].https://doi.org/10.3389/fimmu.2024.1511855. [9] HAN G R,ZHOU G L,CHEN C,et al.Efficacy of pegylated interferon alpha-2b therapy in nucleos(t)ide analogue-treated HBV postpartum women:an exploratory study[C]//The Liver Meeting2021.Alexandria:AASLD,2021:Abstract-860. [10] 朱鑫月,周玉付,朱诗国.乙型肝炎病毒感染致自然杀伤细胞功能受损的研究现状[J].中华肝脏病杂志,2025,33(3):300-306. [11] GILL U S,PEPPA D,MICCO L,et al.Interferon alpha induces sustained changes in NK cell responsiveness to hepatitis B viral load suppression in vivo[J/OL].PLoS Pathog,2016,12(8)[2026-02-05].https://doi.org/10.1371/journal.ppat.1005788. [12] ZHANG L,JIANG T T,YANG Y,et al.Postpartum hepatitis and host immunity in pregnant women with chronic HBV infection[J/OL].Front Immunol,2023,13[2026-02-05].https://doi.org/10.3389/fimmu.2022.1112234. [13] FLETCHER S P,CHIN D J,GRUENBAUM L,et al.Intrahepatic transcriptional signature associated with response to interferon-α treatment in the woodchuck model of chronic hepatitis B[J/OL].PLoS Pathog,2015,11(9)[2026-02-05].https://doi.org/10.1371/journal.ppat.1005103. [14] BERTOLETTI A.The immune response in chronic HBV infection[J].J Viral Hepat,2024,31(Suppl. 2):43-55. [15] BOZWARD A G,WOOTTON G E,PODSTAWKA O,et al.Autoimmune hepatitis:tolerogenic immunological state during pregnancy and immune escape in post-partum[J/OL].Front Immunol,2020,11(S2)[2026-02-05].https://doi.org/10.3389/fimmu.2020.591380. [16] HOU J L,HAO Y H,GAO Y F,et al.Dynamic changes of T-cell immunity in women with chronic HBV infection during pregnancy and postpartum and its relationship with HBV infection status[C]//The Liver Meeting2023.Alexandria:AASLD,2023:Abstract-74. [17] FENG H,ZHAO Z X,ZHAO X H,et al.A novel memory-like Tfh cell subset is precursor to effector Tfh cells in recall immune responses[J/OL].J Exp Med,2024,221(1)[2026-02-05].https://doi.org/10.1084/jem.20221927. [18] 林金,曾煜,田展飞,等.组织驻留记忆T细胞在慢性肝病中的调控机制与治疗靶点[J].临床肝胆病杂志,2025,41(5):975-982. [19] 薛鑫源,徐友娣.CD4+CD25+调节性T细胞与妊娠关系的研究进展[J].中华围产医学杂志,2012,15(6):375-378. [20] XIONG H J,ZHOU C J,QI G N.Proportional changes of CD4+CD25+Foxp3+ regulatory T cells in maternal peripheral blood during pregnancy and labor at term and preterm[J].Clin Invest Med,2010,33(6):422-428. [21] NARMADA B C,KHAKPOOR A,SHIRGAONKAR N,et al.Single-cell landscape of functionally cured chronic hepatitis B patients reveals activation of innate and altered CD4-CTL-driven adaptive immunity[J].J Hepatol,2024,81(1):42-61. [22] HUANG M T,GAO Y F,YIN X R,et al.Characterization of T cell immunity in chronic hepatitis B virus-infected mothers with postpartum alanine transaminase flare[J/OL].BMC Infect Dis,2021,21(1)[2026-02-05].https://doi.org/10.1186/s12879-021-06634-2. [23] XIE J W,WANG J,CUI X J.Research progress on estrogen and estrogen receptors in the occurrence and progression of autoimmune thyroid diseases[J/OL].Autoimmun Rev,2025,24(6)[2026-02-05].https://doi.org/10.1016/j.autrev.2025.103803. [24] ABDULHUSSAIN G,AZIZIEH F,MAKHSEED M,et al.Effects of progesterone,dydrogesterone and estrogen on the production of Th1/Th2/Th17 cytokines by lymphocytes from women with recurrent spontaneous miscarriage[J/OL].J Reprod Immunol,2020,140[2026-02-05].https://doi.org/10.1016/j.jri.2020.103132. [25] BUSCHOW S I,JANSEN D T S L.CD4+ T cells in chronic hepatitis B and T cell-directed immunotherapy[J/OL].Cells,2021,10(5)[2026-02-05].https://doi.org/10.3390/cells10051114. [26] WANG B,ZHAO X P,FAN Y C,et al.IL-17A but not IL-22 suppresses the replication of hepatitis B virus mediated by over-expression of MxA and OAS mRNA in the HepG2.2.15 cell line[J].Antivir Res,2013,97(3):285-292. [27] WU L L,LI X Y,DENG K,et al.Predictive value of Th17 and Treg cells at baseline for HBsAg loss in chronic hepatitis B patients with low HBsAg quantification treated with pegylated interferon and nucleos(t)ide analogue[J].Liver Res,2023,7(2):136-144. [28] KONISHI A,SUZUKI J,KUWAHARA M,et al.Glucocorticoid imprints a low glucose metabolism onto CD8 T cells and induces the persistent suppression of the immune response[J].Biochem Biophys Res Commun,2022,588:34-40. [29] TAVES M D,ASHWELL J D.Glucocorticoids in T cell development,differentiation and function[J].Nat Rev Immunol,2021,21(4):233-243. [30] KHANAM A,CHUA J V,KOTTILIL S.Immunopathology of chronic hepatitis B infection:role of innate and adaptive immune response in disease progression[J/OL].Int J Mol Sci,2021,22(11)[2026-02-05].https://doi.org/10.3390/ijms22115497. [31] LU J F,WANG X X,ZHU Y X,et al.Clinical and immunological factors associated with postpartum hepatic flares in immune-tolerant pregnant women with hepatitis B virus infection treated with telbivudine[J].Gut Liver,2021,15(6):887-894. [32] YI W,PAN C Q,LI M H,et al.The characteristics and predictors of postpartum hepatitis flares in women with chronic hepatitis B[J].Am J Gastroenterol,2018,113(5):686-693. [33] OUYANG S,GENG Y W,QIU G Q,et al.Postpartum hepatitis flares in mothers with chronic hepatitis B infection[J/OL].Gastroenterol Rep,2024,12[2026-02-05].https://doi.org/10.1093/gastro/goae091. [34] ZHOU L Y,LIU X T,OU X T,et al.Chronic hepatitis B in women of childbearing age and pregnant women in China:a cross-sectional study[J].Am J Trop Med Hyg,2024,110(4):719-723. [35] ZHOU Y H.Unnecessary to extend postpartum antiviral therapy in pregnant women with high hepatitis B viral loads[J].J Clin Gastroenterol,2019,53(6):473-474. [36] GHANY M G,PAN C Q,LOK A S,et al.AASLD ISDA Practice Guideline on treatment of chronic hepatitis B[J/OL].Hepatology,2025[2026-02-05].https://doi.org/10.1097/HEP.0000000000001549. [37] World Health Organization.Guidelines for the prevention,diagnosis,care and treatment for people with chronic hepatitis B infection[M].Geneva:WHO,2024. [38] KUMAR M,ABBAS Z,AZAMI M,et al.Asian Pacific association for the study of liver(APASL)guidelines:hepatitis B virus in pregnancy[J].Hepatol Int,2022,16(2):211-253. [39] European Association for the Study of the Liver.EASL Clinical Practice Guidelines on the management of hepatitis B virus infection[J].J Hepatol,2025,83(2):502-583. [40] 刘锦锋,曾庆磊,纪泛扑.中国乙型肝炎病毒母婴传播防治指南(2024年版)[J].临床肝胆病杂志,2024,40(8):1557-1566. [41] 鲁凤民,于乐成,高林,等.HBeAg阴性慢性乙型肝炎患者停药后HBsAg可阴转:停药-治愈策略或许正在来临[J].中华医学杂志,2022,102(40):3160-3166. [42] LIU J F,WANG J,JIN D F,et al.Hepatic flare after telbivudine withdrawal and efficacy of postpartum antiviral therapy for pregnancies with chronic hepatitis B virus[J].J Gastroenterol Hepatol,2017,32(1):177-183. [43] 丁洋,盛秋菊,张翀,等.慢性乙型肝炎病毒感染孕妇妊娠期肝炎发作的临床特点及抗病毒治疗的疗效[J].中华肝脏病杂志,2019,27(2):106-111. [44] FENG Y L,YAO N J,SHI L,et al.Efficacy and safety of long-term postpartum antiviral therapy in hepatitis B virus-infected mothers receiving prophylactic tenofovir disoproxil fumarate treatment[J].Eur J Gastroenterol Hepatol,2023,35(2):212-218. [45] HOU J L,ZHANG W H,XIE Q,et al.Xalnesiran with or without an immunomodulator in chronic hepatitis B[J].N Engl J Med,2024,391(22):2098-2109. [46] SONG A X,LIU Y S,CAO Z H,et al.Clinical features and T cell immune characteristics of postpartum hepatitis flare in pregnant women with HBeAg-positive chronic HBV infection[J/OL].Front Immunol,2022,13[2026-02-05].https://doi.org/10.3389/fimmu.2022.881321. [47] SAMADI KOCHAKSARAEI G,CASTILLO E,SADLER M D,et al.Real-world clinical and virological outcomes in a retrospective multiethnic cohort study of 341 untreated and tenofovir disoproxil fumarate-treated chronic hepatitis B pregnant patients in North America[J].Aliment Pharmacol Ther,2020,52(11/12):1707-1716. [48] TANG Q,WANG C R,LI H,et al.Unexpected HBsAg decrease after nucleoside analogues retreatment among HBeAg positive postpartum women:a pilot study[J/OL].Virol J,2025,22(1)[2026-02-05].https://doi.org/10.1186/s12985-025-02632-x. [49] HIRODE G,CHOI H S J,CHEN C H,et al.Off-therapy response after nucleos(t)ide analogue withdrawal in patients with chronic hepatitis B:an international,multicenter,multiethnic cohort(RETRACT-B study)[J].Gastroenterology,2022,162(3):757-771. [50] 梁携儿,刘智泓,侯金林.乙型肝炎功能性治愈新药:聚焦反义寡核苷酸和小干扰RNA[J].临床肝胆病杂志,2025,41(1):7-14. [51] ZHAO Q,LIU H,TANG L D,et al.Mechanism of interferon alpha therapy for chronic hepatitis B and potential approaches to improve its therapeutic efficacy[J/OL].Antiviral Res,2024,221[2026-02-05].https://doi.org/10.1016/j.antiviral.2023.105782. [52] GOH Z Y,REN E C,KO H L.Intracellular interferon signalling pathways as potential regulators of covalently closed circular DNA in the treatment of chronic hepatitis B[J].World J Gastroenterol,2021,27(14):1369-1391. [53] LU J F,ZHANG S B,LIU Y L,et al.Effect of Peg-interferon α-2a combined with Adefovir in HBV postpartum women with normal levels of ALT and high levels of HBV DNA[J].Liver Int,2015,35(6):1692-1699. [54] ZHONG W T,YAN L Z,ZHU Y G,et al.A high functional cure rate was induced by pegylated interferon alpha-2b treatment in postpartum hepatitis B e antigen-negative women with chronic hepatitis B virus infection:an exploratory study[J/OL].Front Cell Infect Microbiol,2024,14[2026-02-05].https://doi.org/10.3389/fcimb.2024.1426960. [55] GUO Y,JIANG L,LIU M,et al.Efficacy and safety of pegylated interferon alpha-2b in HBV postpartum women with low HBsAg levels:an exploratory study in southwest China[C]//The Liver Meeting2023.Alexandria:AASLD,2023:Abstract-1413-C. [56] 徐小芬,吕美雅.乙型肝炎病毒感染产妇产后抑郁发生情况及原因的调查分析[J].中国医师杂志,2015,17(5):779-780. [57] 庞盼姣,李长安,赵巍峰,等.PEG-IFN α-2b治疗后慢性乙肝患者体内PBMC中的p11 mRNA GRα mRNA水平与抑郁症的相关性[J].临床心身疾病杂志,2023,29(4):1-7.