乙肝、不孕不育与辅助生殖

张灵剑; 张方芳; 马志媛; 金洁

doi:10.1631/jzus.B2300261

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Review | Updated：2024-08-19

乙肝、不孕不育与辅助生殖
Hepatitis B virus infection, infertility, and assisted reproduction
浙江大学学报（英文版）（B辑：生物医学和生物技术） 2024年25卷第8期页码：672-685
Affiliations：

1.Department of Infectious Diseases, Affiliated Hangzhou First People’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
2.Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
3.Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
Funds：

the Key Laboratory of Clinical Cancer Pharmacology, the Zhejiang Provincial Natural Science Foundation of China(LY21H310001);the Zhejiang Province Medical Health Science and Technology Plan Project(2020RC028;2018KY566);the Clinical Research Fund Project of Zhejiang Medical Association(2018ZYC-A30)
DOI：10.1631/jzus.B2300261
中图分类号：
CSTR：
纸质出版日期： 2024-08-15 ，

收稿日期： 2023-04-19 ，

修回日期： 2023-10-23 ，
Accepted：

张灵剑,张方芳,马志媛等.乙肝、不孕不育与辅助生殖[J].浙江大学学报（英文版）（B辑：生物医学和生物技术）,2024,25(08):672-685.

Lingjian ZHANG, Fangfang ZHANG, Zhiyuan MA, et al. Hepatitis B virus infection, infertility, and assisted reproduction[J]. Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology), 2024,25(8):672-685.
张灵剑,张方芳,马志媛等.乙肝、不孕不育与辅助生殖[J].浙江大学学报（英文版）（B辑：生物医学和生物技术）,2024,25(08):672-685. DOI： 10.1631/jzus.B2300261.

Lingjian ZHANG, Fangfang ZHANG, Zhiyuan MA, et al. Hepatitis B virus infection, infertility, and assisted reproduction[J]. Journal of Zhejiang University-SCIENCE B (Biomedicine & Biotechnology), 2024,25(8):672-685. DOI： 10.1631/jzus.B2300261.

摘要

乙型肝炎病毒（HBV）是世界范围内传播最广泛的病毒之一，也是肝炎、肝硬化和肝细胞癌的主要病因。既往研究已经揭示了HBV感染对生育能力的影响。近年来越来越多患有乙肝的不孕夫妇选择通过辅助生殖技术（ART）来满足他们的生育需求。尽管HBV感染率很高，但目前其感染对辅助生殖治疗影响的研究仍较为有限且存在矛盾。本研究旨在全面概述HBV感染对生育能力的影响，并讨论其对妊娠结局、垂直传播、妊娠并发症和ART治疗期间病毒活性的影响。我们通过在PubMed上检索1996年至2022年间发表的关于HBV和ART的研究，发现HBV感染对男性和女性的生育能力均存在负面的影响。现有研究表明，在接受ART治疗的夫妇中，HBV感染可能会增加妊娠并发症的风险。HBV感染对ART妊娠结局的影响目前仍然存在争议，且现有的证据不支持ART增加HBV垂直传播风险的观点，同时相关研究较为有限。随着ART的发展，特别是免疫抑制疗法的广泛应用，HBV再激活（HBVr）的风险正在增加。综上所述，定期进行HBV感染筛查和HBVr风险分层及管理对预防ART期间的HBVr至关重要，但ART期间预防性抗HBV治疗的最佳策略和时机的确定仍需进一步研究。

Abstract

Background

Hepatitis B virus (HBV) is one of the most widespread viruses worldwide and a major cause of hepatitis

cirrhosis

and hepatocellular carcinoma. Previous studies have revealed the impacts of HBV infection on fertility. An increasing number of infertile couples with chronic hepatitis B (CHB) virus infection choose assisted reproductive technology (ART) to meet their fertility needs. Despite the high prevalence of HBV

the effects of HBV infection on assisted reproduction treatment remain limited and contradictory.

Objective

The aim of this study was to provide a comprehensive overview of the effect of HBV infection on fertility and discuss its effects on pregnancy outcomes

vertical transmission

pregnancy complications

and viral activity during ART treatment.

Methods

We conducted a literature search in PubMed for studies on HBV infection and ART published from 1996 to 2022.

Results

HBV infection negatively affected fertility in both males and females. Existing research shows that HBV infection may increase the risk of pregnancy complications in couples undergoing assisted reproduction treatment. The impact of HBV infection on the pregnancy outcomes of ART is still controversial. Current evidence does not support that ART increases the risk of vertical transmission of HBV

while relevant studies are limited. With the development of ART

the risk of HBV reactivation (HBVr) is increasing

especially due to the wide application of immunosuppressive therapy.

Conclusions

Regular HBV infection screening and HBVr risk stratification and management are essential to prevent HBVr during ART. The determination of optimal strategy and timing of prophylactic anti-HBV therapy during ART still needs further investigation.

关键词

辅助生殖技术（ART）乙型肝炎病毒（HBV）免疫抑制剂妊娠

Keywords

Assisted reproductive technology (ART)Hepatitis B virus (HBV)Immunosuppressive agentPregnancy

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