妊娠中晚期使用替诺福韦阻断HBV母婴传播的临床效果及安全性分析  

Clinical efficacy and safety of tenofovir in preventing vertical transmission of hepatitis B virus in women with middle-late pregnancy

作　　者：周艳[1] 周华红 林莹玉 郭颖[4] Zhou Yan;Zhou Huahong;Lin Yingyu;Guo Ying(Department of Infectious Diseases,Guangzhou First People’s Hospital,Guangzhou 510180,China)

机构地区：[1]广州市第一人民医院感染科,广州510180 [2]暨南大学附属顺德医院内科,佛山528305 [3]普宁市人民医院妇产科,普宁515300 [4]广州市第一人民医院妇产科,广州510180

出　　处：《新医学》2018年第11期807-810,共4页Journal of New Medicine

基　　金：广州市科技计划项目(201709010059)

摘　　要：目的探讨替诺福韦用于妊娠中晚期HBV高病毒载量孕妇对阻断母婴传播的临床效果及安全性。方法 96例HBV高病毒载量孕妇按个人意愿分为观察组(60例)和对照组(36例),对照组不给予抗病毒治疗,观察组于妊娠24～28周给予口服替诺福韦至分娩,2组新生儿出生后均予标准免疫预防(乙型肝炎人Ig+乙型肝炎疫苗),比较2组孕妇HBV DNA载量变化、婴儿7月龄时HBsAg、HBV DNA阳性率、新生儿出生时的生长发育情况及围生期不良事件发生率,观察孕妇用药后相关不良反应的发生情况。结果治疗前观察组和对照组患者血清HBV DNA载量组间比较差异无统计学意义(P>0.05)。分娩前,观察组孕妇的血清HBV DNA载量低于对照组(P<0.05)。分娩7个月后,观察组婴儿血清HBsAg、HBV DNA阳性率均为0%,母婴阻断率达100%,对照组婴儿血清HBsAg、HBV DNA阳性率分别为14%、11%,母婴阻断率为86%,2组比较差异均有统计学意义(P均<0.05)。2组新生儿出生时的身长、头围、体质量及围生期不良事件发生率比较差异均无统计学意义(P均>0.05)。观察组孕妇用药后发生相关不良反应3例(5%),其中2例表现为轻微头晕、乏力,1例表现为轻度恶心、食欲减退。结论妊娠中晚期HBV高病毒载量孕妇使用替诺福韦可有效阻断HBV母婴传播,安全性好。Objective To investigate the clinical efficacy and safety of tenofovir in preventing the vertical transmission of hepatitis B virus(HBV)in middlelate pregnant women with high viral load.Methods In total,96 pregnant women with high HBV load were assigned into the observation(n=60)and control groups(n=36)according to their willingness.Patients in the control group did not receive antiviral therapy,and those in the observation group were orally given with tenofovir from 2428 gestational weeks until the delivery.All infants were subject to standard immunization(human HBV immunoglobulin+hepatitis B vaccine).The changes of the HBVDNA level,the positive rate of HBV surface antigen(HBsAg)and HBVDNA at 7 months of age,the growth and development of newborns and the incidence of perinatal adverse events were statistically compared between two groups.The incidence of adverse events induced by tenofovir was observed in the pregnant women.Results Prior to corresponding treatment,the serum HBVDNA level did not significantly differ between two groups(P>0.05).Before the delivery,the serum HBVDNA level in the observation group was significantly lower than that in the control group(P<0.05).For the 7monthold infants,the positive rate of HBsAg and HBVDNA was 0%and the prevention rate of mothertochild transmission of HBV was 100%in the observation group,significantly lower than 14%,11%and 86%in the control group,respectively(allP<0.05).The body length,head circumference,body weight,Apgar score and incidence of perinatal adverse events did not significantly differ between two groups(allP>0.05).In the observation group,3 cases(5%)experienced adverse reactions after use of tenofovir,including 2 cases of slight dizziness and fatigue and 1 case of mild nausea and anorexia.Conclusion Application of tenofovir is an efficacious and safe approach to prevent the vertical transmission of HBV in middlelate pregnant women.

关 键 词：替诺福韦 妊娠中晚期 乙型肝炎病毒 母婴传播 

分 类 号：R714.251[医药卫生—妇产科学]