替比夫定/拉米夫定序贯免疫球蛋白乙型肝炎母婴阻断  

Sequential telbivudine/lamivudine and hepatitis B immunoglobulin therapy for preventing mother-to-infant transmission of hepatitis B virus

作　　者：沈美龙[1] 徐洪涛[1] 居红芳[2] 咸建春[1] 杨秀珍[1] 

机构地区：[1]江苏省泰州市人民医院肝病科,江苏省泰州市225300 [2]江苏省泰州市人民医院产科,江苏省泰州市225300

出　　处：《世界华人消化杂志》2016年第23期3517-3522,共6页World Chinese Journal of Digestology

基　　金：江苏省自然基金资助项目;No.BK2011538~~

摘　　要：目的:探讨对乙型肝炎病毒(hepatitis Bvirus,HBV)携带孕妇进行孕中晚期替比夫定/拉米夫定母婴宫内感染阻断序贯以新生儿出生后注射免疫球蛋白(hepatitis B immunoglobulin,HBIG)进行母婴阻断的临床意义.方法:178例入选孕妇分为替比夫定组、拉米夫定组、HBIG组和拒绝阻断组分别阻断,妊娠12 wk进行ALT、总胆红素、乙肝表面抗原(hepatitis B surface antigen,HBs Ag)、乙型肝炎e抗原(hepatitis B e antigen,HBe Ag)滴度、HBV DNA定量、基因分型、耐药及自然杀伤细胞(natural killer cell,NK)细胞绝对值检测,新生儿出生后常规注射乙型肝炎疫苗,并在出生当天,2、4及12 wk时分别注射HBIG 200 IU,检测新生儿脐带血和出生24 wk时乙型肝炎标志物情况,并对药物安全性进行评估.结果:替比夫定组和拉米夫定组入选孕妇经药物阻断12 wk后HBV DNA滴度显著下降,在24 wk时与拒绝阻断组比较差异有统计学意义.替比夫定组、拉米夫定组及HBIG组分别有2例、1例、4例出生时HBs Ag阳性,24 wk复查时替比夫定组、拉米夫定组及HBIG组HBs Ag阳性分别为0例、0例、3例,与24 w k时拒绝阻断组比较有统计学差异(P<0.05).各组新生儿胎龄、平均体质量、Apgar评分比较差异均无统计学意义,各组的婴儿随访至12月龄时,未发生畸形,与拒绝阻断组相比,差异无统计学意义.HBs Ag、HBe Ag、基因分型、基因耐药和NK细胞数与阻断均无明显相关性.结论:HBV携带孕妇进行孕中晚期替比夫定/拉米夫定母婴宫内感染阻断序贯以新生儿出生后注射HBIG能通过抑制高病毒载量,达到母婴阻断的效果.AIM： To assess the value of sequential telbivudine/ lamivudine and hepatitis B immunoglobulin （HBIG） therapy in preventing mother-to-infant transmission of hepatitis B virus （HBV）. METHODS： One hundred and seventy-eight enrolled pregnant women were divided into a telbivudine group, a lamivudine group, an HBIG group and a non-preventive group, and they were given the respective drug for preventing mother-to-infant transmission of HBV. At gestational week 12, alanine aminotransferase, total bilirubin, HBsAg, HBeAg, HBV DNA, HBV genotyping, drug resistance related mutations and natural killer cells were detected. Newborns were routinely injected with hepatitis B vaccine, and the HBIG group was additionally given HBIG 200 IU at birth, 3 and 12 wk after birth. Serum levels of HBsAg and HBeAg were detected at birth and 24 wk after birth. The safety of telbivudine and lamivudine was evaluated.RESULTS： At 22 wk after receiving antiviral drugs, HBV DNA level was significantly reduced in the telbivudine and lamivudine groups compared with the non-preventive group （P 〈 0.05）. No significant difference was observed in gestational age, mean weight or Apgar score of newborns in each group. In addition, no significant difference was observed in alanineaminotransferase, total bilirubin, HBsAg, HBeAg, HBV DNA, HBV genotype, drug resistance related mutations or natural killer cells in each group CONCLUSION： HBV DNA level can be significantly inhibited by sequential telbivudine/lamivudine and hepatitis B immunoglobulin therapy in pregnant women with high viral load, which can prevent mother-to-infant transmission of HBV.

关 键 词：替比夫定 拉米夫定 免疫球蛋白 HBV DNA 母婴阻断 

分 类 号：R714.251[医药卫生—妇产科学]