妊娠后期应用替比夫定阻断HBV高载量孕妇母婴传播效果及安全性  

Efficacy and safety of telbivudine in preventing the transmission of HBV from mother to child in late pregnancy in women with high viral load

作　　者：楼建军[1] 张君鸣[1] 王玉华 俞如葵 

机构地区：[1]余姚市人民医院感染科,浙江余姚315400 [2]余姚市妇幼保健所妇保科,浙江余姚315400

出　　处：《中国微生态学杂志》2015年第12期1464-1467,共4页Chinese Journal of Microecology

摘　　要：目的评价妊娠后期应用替比夫定（LdT）阻断HBV高载量孕妇母婴传播的疗效及安全性。方法选择185例2012年5月1日至2013年4月30日在余姚市人民医院门诊就诊及住院的HBsAg阳性、HBV DNA≥2.0×10^5 IU/mL、肝功能正常的妊娠妇女,按照患者意愿分为治疗组（127例,自孕28周至产后30d口服LdT 600mg/d）和对照组（58例,未服药）。两组孕妇均在孕26-27周、分娩时及产后30d检测HBV DNA。两组婴儿在出生后6h内、30d、6个月注射乙型肝炎疫苗10μg,同时在婴儿出生后6h内及产后30d注射乙型肝炎免疫球蛋白200IU。在婴儿7-8月龄时检测HBsAg情况。结果治疗组孕妇在分娩时及产后30dHBV DNA滴度明显下降,HBV DNA的阴转率为22.04%,在分娩时HBV DNA水平与对照组相比差异有统计学意义（P=0.001）;治疗组婴儿HBsAg阳性率为0.00%,对照组为5.17%（3例感染）,两组比较差异有统计学意义（P=0.01）。两组患者在剖宫产率、产后出血率、早产率、新生儿先天畸形率、正常体重儿等方面差异无统计学意义。结论 HBV DNA高载量孕妇在妊娠后期实施抗病毒治疗,能有效抑制孕妇体内HBV DNA水平,降低HBV母婴垂直传播率。Objective To evaluate the efficacy and safety of telbivudine（LdT）for prevention of mother-to-infant transmission of HBV in late term of pregnancy in women with high HBV DNA load.Methods Pregnant women admitted from May 1,2012 to April 30,2013 in the People＇s Hospital of Yuyao,who were HBsAg-positive with normal liver function and HBV DNA of no less than 2.0×10^5 IU/mL,were enrolled and divided into treatment group（127cases）or control group（58cases）according to their personal preference.The Treatment group received orally telbivudine from week 28 of pregnancy to postpartum day 30.HBV DNA was measured at week 26 or 27of pregnancy,intra-partum and postpartum day 30.The control group was not given antiviral treatment.All delivered infants were administered hepatitis B immune globulin（HBIG;200IU）and recombinant HBV vaccine（10μg）at 6hours of delivery and 30 days after birth as well as one more recombinant HBV vaccine at 6months.The levels of HBsAg of the infants were measured at postpartum month 7or 8.Results The levels of HBV DNA in treatment group were？significantly decreased at intra-partum and postpartum day 30;the rate of negative conversion was 22.04%.The levels of HBV DNA were significantly lower in the treatment group than in the control group at intra-partum（P=0.001）.The positive rate of HBsAg was 0.00%in infants in the treatment group,while 5.17%in the control group（P=0.01）.There were no differences in the rates of cesarean section,postpartum hemorrhage,premature birth,the rate of birth defects,or infants＇ height/weight between the two groups.Conclusion LdT used during late term of pregnancy in mothers who have high HBV DNA load can obviously？control？the levels of HBV DNA in blood,and reduce the infection rate of HBV in infants.

关 键 词：替比夫定 乙型肝炎病毒 妊娠后期 母婴传播 

分 类 号：R714.2[医药卫生—妇产科学]