妊娠后期应用替诺福韦治疗血清HBV高载量孕妇阻断HBV母婴传播的疗效及安全性分析  

Efficacy and safety of tenofovir in the treatment of pregnant women with high HBV DNA loads Ma

作　　者：马丽英 沈利娟[2] Ma Liying;Shen Lijuan(Department of Rehabilitation and Health Care,Department of Clinical Medicine,Vocational and Technical College,Xining 810000,Qinghai Province,China)

机构地区：[1]西宁市青海卫生职业技术学院临床医学系康复保健教研室,810000 [2]青海大学附属医院消化科

出　　处：《实用肝脏病杂志》2019年第6期836-839,共4页Journal of Practical Hepatology

基　　金：青海省自然科学基金资助项目(编号:2017297)

摘　　要：目的探讨在妊娠后期应用替诺福韦抗病毒治疗阻断HBV高载量孕妇HBV母婴传播的效果及安全性。方法2015年3月~2017年9月我院诊治的HBV高载量孕妇83例,其中56例在妊娠28周接受替诺福韦口服抗病毒药物至分娩结束,另27例未接受抗病毒治疗。两组新生儿在出生后立即注射乙肝免疫球蛋白(HBIG)和乙肝疫苗,在婴儿出生12个月时检测血清HBV DNA、HBeAg和HBsAg水平,判断感染阻断情况。结果在分娩时,接受抗病毒治疗妇女血清HBV DNA水平为(3.9±0.7)lg IU/ml,显著低于未抗病毒组[(7.6±0.5)lg IU/ml,P<0.05],血清HBsAg水平为(674.3±301.9)IU/ml,显著低于未抗病毒组[(1104.1±401.2)IU/ml,P<0.05],血清HBeAg水平为(2059.8±996.4)s/co,显著低于对照组[(3479.4±1287.6)s/co,P<0.05];抗病毒组HBV母婴传播阻断率为100.0%,显著高于未抗病毒组的81.5%(P<0.05);抗病毒孕妇均未出现因药物治疗而引起的不良反应,两组新生儿出生时各项生长发育指标比较差异无统计学意义(P>0.05)。结论在妊娠后期应用替诺福韦抗病毒治疗HBV高载量孕妇对阻断HBV母婴传播效果好,安全性高。Objective To investigate the efficacy and safety of tenofovir in the treatment of pregnant women with high serum HBV DNA loads.Methods The study had selected 83 pregnant women with high serum HBV DNA loads between March 2015 and September 2017,and 56 cases of them received tenofovir for antiviral therapy at the late gestation,and 27 didn’t.All the newborns received immediately hepatitis B immunoglobulin(HBIG)and hepatitis B vaccine after birth,and all the infants were followed-up for 12 months.The HBV infection was defined by serum HBsAg and/or HBV DNA positive.Results Serum HBV DNA load in women receiving tenofovir after delivery was(3.9±0.7)lg IU/ml,significantly lower than[(7.6±0.5)lg IU/ml,P<0.05],serum HBsAg level was(674.3±301.9)IU/ml,significantly lower than[(1104.1±401.2)IU/ml,P<0.05],and serum HBeAg level was(2059.8±996.4)s/co,significantly lower than[(3479.4±1287.6)s/co,P<0.05]in those without antiviral therapy;the successful block of mother-to-infant HBV infection in women with antiviral therapy was 100.0%,much higher than 81.5%(P<0.05)in those without;there was no adverse reaction caused by antiviral agent in tenofovir-treated women,and there was no significant difference in the growth and development indexes of newborns at birth between the two groups(P>0.05).Conclusion The antiviral therapy with tenofovir administration for pregnant women with high serum HBV DNA loadS in late pregnancy has good effect on blocking intrauterine HBV infection with very good clinical safety.

关 键 词：乙型肝炎 妊娠 替诺福韦 母婴传播 阻断 

分 类 号：R51[医药卫生—内科学]