替比夫定阻断乙型肝炎病毒母婴传播有效性的Meta分析  

A meta-analysis for the effectiveness of telbivudine on preventing mother-to-child transmission of hepatitis B virus

作　　者：丁云[1] 易建华[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院感染病科,武汉430022

出　　处：《临床内科杂志》2016年第7期480-484,共5页Journal of Clinical Internal Medicine

摘　　要：目的评价替比夫定在妊娠晚期阻断乙型肝炎病毒（HBV）母婴传播的有效性。方法在万方数据库、Sinomed、中国知网等数据库中根据主题词检索2007年1月～2014年6月的替比夫定阻断HBV母婴传播文献，提取合格文献中数据资料后，应用RevMan5．2软件进行Meta分析。结果共纳入20篇文献，纳入文献数据整合后经分析，替比夫定组共纳入孕妇731例，对照组共纳入孕妇868例，共1599例受试者。替比夫定组孕妇分娩时血清HBVDNA定量水平较入组时明显下降，差异有统计学意义[WMD（加权均数差）=-4．26，95％CI：-4．78～-3．74，P〈0．01]，且低于对照组孕妇分娩时HBVDNA水平，差异有统计学意义（WMD=-4．05，95％CI：-4．50--3．61，P〈0．01）；替比夫定组新生儿出生后24h内，血清HBVDNA水平、血清HBsAg阳性率均低于对照组新生儿，差异有统计学意义（OR=0．35，95％CI：0．24—0．46，P〈0．01；OR=0.16，95％CI：0．09～0．29，P〈0．01）；随访至婴儿6个月龄时，替比夫定组婴儿血清HBsAg阳性率低于对照组，差异有统计学意义（OR=0．15，95％CI：0．04～0．58，P〈0．01）；随访至婴儿12个月龄时，替比夫定组婴儿HBsAg阳性率低于对照组婴儿，差异有统计学意义（OR=0．13，95％CI：0．06～0．26，P〈0．01）。结论对于高病毒载量的孕妇（妊娠期间血清HBVDNA〉10×10^7copies／ml），在妊娠晚期给予替比夫定抗病毒治疗联合新生儿主被动双重免疫能够有效降低HBV母婴垂直传播的发生率。Objective To evaluate the effectiveness of telbivudine treating in the late gestation with chronic hepatitis B blocking mother-to-child transmission of hepatitis B virus. Methods Literatures concerning the effects of telbivudine on blocking mother-to-child transmission in the databases of WANFANG, Sinomed and CNKI from January 2007 to June 2014 were searched. The meta-analysis was performed by RevMan 5.2 software after the extraction of data. Results A total of 20 studies involving 1 599 patients were included. 731 pregnant women were selected into telbivudine group and 868 pregnant women into the control group. The HBV DNA level of pregnant women significantly reducted after treatment in the teibivudine group（WMD = -4.26,95% CI： -4. 78, -3.74,P 〈0.01） ,and was lower than those in control group before parturition（ WMD = - 4.06,95% CI： - 4. 50, - 3. 61 ,P 〈 0.01 ）. Infants born to telbivudine-treated mothers had lower rate of HBsAg seropositivity and HBV DNA level at birth than infants of the control group （ OR = 0. 35,95 % CI： 0. 24,0. 46, P 〈 0. 01 ; OR = 0. 16,95 % CI： 0. 09,0. 29, P 〈 0.01 ）. Infants born to telbivudine-treated mothers also had significantly lower rates of HBsAg seropositivity at 6 months and 12 months（ OR = O. 15,95 % CI：O. 04,0. 58, P 〈 0. 01;OR = 0. 13, 95 % C1：0. 06,0. 26, P 〈 0.01 ）. Conclusion For high viral load of pregnant women infected HBV （ viral load is higher than 10 × 107 copies/ml） , antiviral treatment with teibivudine in late pregnancy joint newborn main passive dual immunity can effectively reduce the incidence of mother-to-child transmission of HBV.

关 键 词：替比夫定 母婴传播 乙型肝炎病毒 宫内感染 

分 类 号：R186[医药卫生—流行病学]