拉米夫定阻断乙肝病毒宫内感染停药策略探讨  

Study of the Strategy about Cessation of Lamivudine Used in HBV Intrauterine Infection

作　　者：曾艳梅[1] 陈蓉[2] 娄国强[1] 施军平[2] 

机构地区：[1]杭州师范大学附属医院,310015 [2]浙江中医药大学附属第六医院

出　　处：《医学研究杂志》2013年第2期87-90,共4页Journal of Medical Research

基　　金：浙江省医药卫生科学研究基金资助项目(2009B132)

摘　　要：目的通过观察乙肝病毒携带孕妇孕晚期服用拉米夫定,不同时间停药后妊娠妇女的病情变化,探讨拉米夫定阻断乙肝病毒胎儿宫内感染的最佳停药时间。方法将120例HBsAg和HBeAg双阳性且HBV DNA≥105拷贝/毫升、肝功能正常的孕妇分为对照组、治疗Ⅰ、Ⅱ、Ⅲ组,每组各30例。各治疗组自孕28周开始口服拉米夫定100mg/d,治疗Ⅰ组分娩后停药,治疗Ⅱ组分娩后4周停药,治疗Ⅲ组分娩后6周停药,对照组30例不用药。4组均于孕26～28周和分娩前检测肝功能、HBV-M(乙肝标志物)、HBV-DNA定量。治疗Ⅰ、Ⅱ、Ⅲ组停药后1、3、6个月及对照组产后1、3、6个月分别检测产妇肝功能、HBV-M、HBV-DNA。新生儿出生断脐后立即检测静脉血HBV-M、HBV-DNA定量,再注射乙肝免疫球蛋白200IU和乙肝疫苗10μg。结果治疗组分娩前HBV-DNA定量及胎儿宫内感染率明显低于对照组(P<0.05)。治疗Ⅰ、Ⅱ、Ⅲ组停药后1、3、6个月与对照组产后1、3、6个月肝功能异常率无明显差异(P>0.05),且与停药时间和是否用药无明显关系。治疗Ⅰ、Ⅱ、Ⅲ组停药后1个月HBV-DNA均回复至治疗前水平,HBV-M均无变化。各治疗组孕妇及新生儿未发现不良反应。结论拉米夫定用于妊娠晚期阻断乙肝病毒宫内感染安全有效,高病毒载量乙肝携带的孕妇分娩后即可停药,停药后需定期检查肝功能及HBV-DNA。Objective To investigate the best time to stop lamivudine on interruption of HBV intrauterine infection through observing the changes of HBV carriers that are in third trimester of pregnancy after treatment of lamivudine for different time. Methods One hun- dred and twenty cases of HBsAg, HBeAg double - positive, HBV DNA ≥ 10^5 copy/ml, normal liver function pregnant women were divided into control group and treatment group Ⅰ、Ⅱ、Ⅲ with 30 cases in each group. Patients in each treatment group started to take lamivudine 100mg/d from the 28th week of pregnancy and group I ended after delivery, group II ended until the 4th week after delivery, group III en- ded until the 6th week after delivery. In control group, patients didn＇t take laminvdine. Liver function, ItBV - M, HBV - DNA were test-ed in all groups during the 26th and 28th pregnancy and before delivery. Liver function, HBV - M, HBV - DNA of pregnant women were tested after 1, 3, 6 months of lamivudine cessation in group Ⅰ、Ⅱ、Ⅲ and 1, 3, 6 months after delivery in control group. At birth, infants vaccinated HBIG 200IU and hepatitis B 10μg after collecting vein blood of them for HBV - M, HBV - DNA test. Results The HBV - DNA quantity before delivery and fetal intrauterine infection rate of treatment group were significantly lower than control group. There was no significant difference in liver function abnormality rate among group Ⅰ、Ⅱ、Ⅲ after 1, 3, 6 months of lamivudine cessation and control group after 1, 3, 6 months of delivery, and the results had no obvious relations to the time of lamivudine cessation and whether or not pa- tients took lamivudine. HBV - DNA came to the level before treatment in group Ⅰ、Ⅱ、Ⅲ after lamivudine cessation for one month and HBV- M had no changes. No adverse reactions to pregnant women and newborns in each treatment group had been found. Conclusion Lamivudine is safe and effective for the interruption of HBV fetal intrauterine infection in the third trimester of pregnancy. Pregnant wome

关 键 词：拉米夫定 乙肝病毒 胎儿 宫内感染 停药 

分 类 号：R512.62[医药卫生—内科学]