妊娠中期慢性乙型肝炎抗病毒治疗的疗效及安全性分析  

Efficancy and safty of antiviral treatment for chronic hepatitis B patients in second trimester of pregnancy

作　　者：蒋小仙[1] 黄文豹[1] 吴旻[1] 潘韵峰[1] 厉慧琴 金洁[1] 

机构地区：[1]杭州市第一人民医院感染科,310006

出　　处：《中华临床感染病杂志》2015年第3期238-242,共5页Chinese Journal of Clinical Infectious Diseases

摘　　要：目的：探讨妊娠中期慢性乙型肝炎（ CHB）抗病毒治疗的疗效及安全性。方法收集2010年1月至2013年12月就诊于杭州市第一人民医院感染科及杭州西溪医院的79例妊娠中期CHB患者。根据患者意愿分为抗病毒治疗组（47例）和护肝治疗组（32例）。抗病毒治疗组在护肝治疗的基础上给予拉米夫定或替比夫定，护肝治疗组仅予保肝降酶治疗。所有妊娠妇女观察至产后12周，新生儿随访至出生后第6个月。采用t检验或χ2检验比较两组肝功能、HBV DNA载量、HBV血清学标志物的变化，妊娠期严重不良事件、HBV母婴阻断传播及新生儿生长发育情况。结果抗病毒治疗组分娩前的丙氨酸转氨酶（ ALT ）复常率和 HBV DNA 不可检测率分别为88.6％（39／44）和84.1％（37／44），而护肝治疗组分别为60.0％（18／30）和0，两组比较差异有统计学意义（χ^2＝8.27和50.46，P＜0.05）。分娩后12周，抗病毒治疗组的ALT复常率和HBV DNA不可检测率均为100.0％（44／44），而护肝治疗组分别为90.0％（27／30）和0，两组差异有统计学意义（χ^2＝4.59和74.00，P＜0.05）。抗病毒治疗组在分娩前及分娩后12周分别有2.8％（1／36）及11.1％（4／36）实现HBeAg血清学转换，而护肝组均为0，但两组比较无统计学差异（ P＞0.05）。抗病毒治疗组因肝损伤或药物不良反应终止妊娠率为0，护肝治疗组为6.7％（2／30），差异无统计学意义（χ^2＝1.01，P＞0.05）。抗病毒治疗组母婴阻断失败率为0，护肝治疗组为11.5％（3／26），差异有统计学意义（χ^2＝5.19，P＜0.05）。两组新生儿在胎龄、体质量、身长及Apgar评分方面差异均无统计学意义（t＝0.65、0.84、0.25和0.77，P＞0.05）。结论妊娠中期抗病毒治疗可改善肝功能水平，有效抑制HBV 复制，减少HBV母婴传播的风险，且安全性良好。Objective To evaluate the efficacy and safty of antiviral treatment for chronic hepatitis B （ CHB ） patients in second trimester of pregnancy.Methods Seventy-nine CHB patients in second trimester of pregnancy were collected from Hangzhou First People’ s Hospital and Xixi Hospital of Hangzhou during January 2010 to December 2013.Patients were divided into antiviral treatment group （ n=47） and the control group （n=32） according to their own wishes.Patients in antiviral treatment group were given lamivudine or telbivudine treatment plus hepatoprotective medication, while those in control group were only given hepatoprotective medication.All pregnant women were observed for 12 weeks after childbirth and the neonates were followed-up for 6 months after birth.The liver function, HBV DNA loads, HBV serological markers were measured;adverse effects during pregnancy, blocking rates of mother-to-child transmission and the growth of neonates were documented.t test or Chi-square test was used for statistical analysis.Results Alanine aminotransferase （ ALT） normalization rate and HBV DNA negative rate in antiviral treatment group before childbirth were 88.6%（39/44） and 84.1%（37/44） , while those in the control group were 60.0%（18/30） and 0 （χ^2 =8.27 and 50.46, P〈0.05）.After 12 weeks of childbirth, ALT normalization rate and HBV DNA negative rate in antiviral treatment group were both 100.0% （44/44）, which were higher than those in control group （90.0%and 0） （χ^2 =4.59 and 74.00, P〈0.05）.HBeAg seroconversion was observed in 1 （2.8%） and 4 （11.1%） patients in antiviral treatment group before and 12 weeks after childbirth, but it was not observed in the control group.The difference in HBeAg seroconversion rate bwteen two groups was not of statistical significance （P〉0.05）.No patient in antiviral treatment group terminated pregnancy due to abnormal liver function or adverse effect of drugs, while 2 out of 30 patients （6.7%） in the control group terminated the

关 键 词：妊娠 肝炎 乙型 慢性 拉米夫定 替比夫定 治疗结果 安全性 

分 类 号：R714[医药卫生—妇产科学]