替比夫定对乙型肝炎病毒母婴阻断效果的Meta分析  

Efficacy of telbivudine on preventing mother-to-child transmission of hepatitis B virus: a Meta-analysis

作　　者：周泓羽[1] 杜渝平[1] 袁喆[2] 

机构地区：[1]重庆医科大学附属第一医院预防保健科,重庆400016 [2]重庆医科大学附属第一医院感染科,重庆400016

出　　处：《第三军医大学学报》2013年第20期2220-2225,共6页Journal of Third Military Medical University

摘　　要：目的综合评价替比夫定阻断乙型肝炎病毒母婴传播的效果。方法检索国内外有关替比夫定阻断HBV母婴传播的临床对照试验文献,通过Meta分析方法,对HBV感染孕妇的HBV DNA定量水平及婴儿HBsAg、HBV DNA血清学阳性率进行合并分析。结果替比夫定组孕妇HBV DNA水平较治疗前下降(WMD=3.62,95%CI=3.41～3.82,P<0.01),且分娩前HBV DNA水平低于对照组(WMD=-3.51,95%CI=-3.79～-3.23,P<0.01)。婴儿出生后24 h内,替比夫定组的HBsAg阳性率、HBV DNA阳性率分别为11.5%、3.9%,低于对照组的25.8%、17.7%(RR=0.45,95%CI=0.32～0.63,P<0.01;RR=0.26,95%CI=0.15～0.44,P<0.01)。婴儿6月龄,替比夫定组的HBV DNA阳性率为2.6%,低于对照组的19.2%(RR=0.15,95%CI=0.06～0.39,P<0.01)。婴儿12月龄,替比夫定组的HBsAg阳性率、HBV DNA阳性率分别为3.8%、2.2%,低于对照组的21.5%、16.6%(RR=0.18,95%CI=0.09～0.39,P<0.01;RR=0.15,95%CI=0.06～0.38,P<0.01)。结论在孕中后期使用替比夫定进行抗病毒治疗,能够降低孕妇乙肝病毒载量,最终起到较好的乙型肝炎病毒母婴阻断效果。Objective To evaluate the efficacy of telbivudine on preventing mother-to-child transmission of hepatitis B virus （HBV）, and to provide a basis for the prevention and control of mother-to-child transmission of HBV. Methods We retrieved the domestic and foreign literatures about controlled clinical trials of telbivudine preventing mother-to-child transmission of HBV. Meta-analysis was used to analyze HBV DNA level of HBV-infected pregnant women, and HBsAg and HBV DNA seropositivity of infants. Results The HBV DNA level of pregnant women of telbivudine group was decreased after treatment （WMD=3.62, 95%CI=3.41 to 3.82, P〈0.01）,and was lower than those in control group before parturition （WMD=-3.51, 95%CI=-3.79 to -3.23, P〈0.01）. Within 24 hours after infants birth, the seropositivity of HBsAg and HBV DNA of telbivudine group infants were 11.5% and 3.9% respectively, lower than those in control group, 25.8% and 17.7% respectively （RR=0.45, 95%CI=0.32 to 0.63, P〈0.01; RR=0.26, 95%CI=0.15 to 0.44, P〈0.01）. The HBV DNA seropositivity of 6-month infants from telbivudine group was 2.6%, lower than 19.2% for the control group （RR=0.15, 95%CI=0.06 to 0.39, P〈0.01）. The seropositivity of HBsAg and HBV DNA of 12-month infants from telbivudine group were 3.8% and 2.2% respectively, lower than 21.5% and 16.6% for the control group （RR=0.18, 95%CI=0.09 to 0.39, P〈0.01; RR=0.15, 95%CI=0.06 to 0.38, P〈0.01）. Conclusion Telbivudine treatment during the second and third trimester of pregnancy reduces HBV DNA level in pregnant women, and ultimately prevents mother-to-child transmission of HBV.

关 键 词：肝炎病毒 乙型 替比夫定 母婴传播 效果 荟萃分析 

分 类 号：R181.23[医药卫生—流行病学] R512.62[医药卫生—公共卫生与预防医学]