妊娠期不同阶段给予替比夫定阻断乙型肝炎病毒宫内母婴传播的研究  

Application of telbivudine before or after pregnancy in blocking intrauterine mother-to-child transmission of hepatitis B virus in human

作　　者：邱波[1] 朱玲[1] 陈艳[2] 吴晓丽[2] 刘秀丽[2] 王堂明 严世春 刘星妤[3] 

机构地区：[1]四川省攀枝花市疾病预防控制中心,617000 [2]四川省攀枝花市中心医院妇产科 [3]四川省攀枝花市第四人民医院肝病治疗中心

出　　处：《实用肝脏病杂志》2016年第4期428-431,共4页Journal of Practical Hepatology

摘　　要：目的探讨妊娠不同阶段给予替比夫定治疗阻断乙型肝炎病毒母婴传播的效果和安全性。方法选择血清HBsAg阴性父亲,血清HBsAg和HBV DNA阳性孕妇180例,干预1组60例,在孕前口服替比夫定,直至HBV DNA阴性后受孕并继续服药至新生儿出生;干预2组60例,在孕24 w时口服替比夫定至新生儿出生;对照组60例不进行抗病毒处理。观察婴儿0 w、24 w和48 w时血清HBsAg和HBV DNA阳性情况。结果干预1组婴儿出生时、24 w、48 w血清HBsAg和HBV DNA阳性率均为0.0%,干预2组出生时、24 w、48 w时HBV DNA阳性率为5.0%、3.3%、3.3%,两组有统计学差异(P<0.01);对照组出生时、24 w、48 w血清HBV DNA阳性率为20.0%、18.3%、16.7%,与干预2组比有统计学差异(P<0.05);干预组未发现与应用替比夫定相关的不良反应;三组新生儿胎龄、体质量、身长和Apgar评分比较无统计学差异(P>0.05)。结论口服替比夫定至HBV DNA阴性时受孕可以完全阻断乙型肝炎病毒母婴宫内传播,且有较好的孕妇和新生儿安全性。Objective To explore the efficacy and safety of telbivudine （LDT） in blocking mother-to-child hepatitis B virus （HBV） transmission before or after pregnancy in human. Method 180 serum HBsAg-positive young women whose husbands were HBsAg-negative were recruited in this study. The women in group A （n=60） received oral administration of telbivudine before and throughout their pregnancy, and the pregnancy began not until their serum HBV DNA turned negative;the women in group B （n=60） received oral administration of telbivudine from 24-week gestation to the delivery,and the in control group （n=60） received no anti-viral treatment. The positive rates of serum HBsAg and HBV DNA in children after birth, at 24 w and at 48 w were recorded. Results The positive rates of serum HBsAg and HBV DNA in intervention group A were both 0.0% at birth,aged at 24-week or 48-week;the positive rates of serum HBV DNA in group B were 5.0%,3.3% and 3.3% at birth , 24 -week and 48-week ages,respectively,and there was a significant difference between group A and group B （P〈0.01）;the positive rates of serum HBV DNA in control group were 20.0%,18.3% and 16.7%, respectively,at birth,24-week and 48-week age,and there was a significant difference between group B and group control （P〈0.05）;no women reported telbivudine discontinuation due to adverse reaction;the gestational age, weight,body length and Apgar＇s score of newborn babies in three groups had no statistical difference. Conclusion Oral administration of telbivudine before pregnancy can result in complete interruption of intrauterine mother-to-child HBV transmission with favorable safety for both pregnant women and newborns.

关 键 词：乙型肝炎 替比夫定 宫内感染 母婴传播 安全性 

分 类 号：R714.251[医药卫生—妇产科学]