孕期抗病毒治疗结合标准阻断措施对乙型肝炎高病毒载量孕妇所生婴儿母婴传播阻断的影响  

Association of maternal antiviral drugs in addition to standard care for prevention of vertical transmission of hepatitis B virus to infants born to mothers with high hepatitis B virus loads

作　　者：张伟[1] 池频频[2] 王富珍[1] 张国民[1] 徐靓亮 万咏梅 梁晓峰[3] Zhang Wei;Chi Pinpin;Wang Fuzhen;Zhang Guomin;Xu Liangliang;Wan Yongmei;Liang Xiaofeng(National Immunization Program,Chinese Center f or Disease Control and Prevention,Beijing 100050,China;Bei jing Ditan Hospital,Capital Medical University,Beijing 100015,China;Chinese Center for Disease Control and Prevention,Beijing 102206,China)

机构地区：[1]中国疾病预防控制中心免疫规划中心,北京100050 [2]首都医科大学附属北京地坛医院,北京100015 [3]中国疾病预防控制中心,北京102206

出　　处：《中国疫苗和免疫》2020年第2期146-150,共5页Chinese Journal of Vaccines and Immunization

基　　金：中国疾控中心科研项目(59911806)。

摘　　要：目的分析乙型肝炎(乙肝)病毒(Hepatitis B virus,HBV)高载量孕妇孕期HBV脱氧核糖核酸(HBV desoxyribonucleic acid,HBV-DNA)水平和HBVe抗原(HBV e antigen,HBeAg)阳性率以及孕期抗病毒治疗结合标准阻断措施对其所生婴儿母婴传播阻断失败率的影响。方法通过医院信息系统收集HBV-DNA高载量(≥2×10^6IU/mL)孕妇血清学检测结果、抗病毒药物使用等信息,描述HBV-DNA载量和HBeAg阳性率;对HBV-DNA高载量孕妇所生婴儿进行乙肝疫苗(Hepatitis B vaccine,HepB)和乙肝免疫球蛋白(Hepatitis B immunoglobulin,HBIG)联合免疫,在完成第3剂HepB后7月龄-2岁对乙肝表面抗原和HBV-DNA进行随访检测,分析母婴传播阻断失败率。结果共纳入1822名HBV-DNA高载量孕妇,接受、未接受抗病毒治疗分别占75.19%、24.81%。孕妇妊娠期、分娩前HBV-DNA≥1.0×10^8IU/mL比例分别为68.10%(933/1370)、0.15%(2/1370)(χ^2=2692.27,P<0.0001)。接受抗病毒治疗组妊娠期、分娩前HBeAg阳性率分别为96.53%(1001/1037)、96.16%(1251/1301)(χ^2=0.23,P=0.635),未接受抗病毒治疗组妊娠期、分娩前HBeAg阳性率分别为97.70%(298/305)、96.98%(417/430)(χ^2=0.36,P=0.550)。两组HepB和HBIG联合免疫后母婴传播阻断失败率分别为0.42%(3/714)、6.67%(14/210)(χ^2=31.69,P<0.0001)。结论孕妇HBV-DNA高载量以≥1.0×10^8IU/mL为主,孕期抗病毒治疗可显著降低孕妇HBV-DNA载量,结合HepB和HBIG联合免疫可显著降低其所生婴儿HBV母婴传播阻断失败率。Objective To analyze hepatitis B virus deoxyribonucleic acid(HBV-DNA)levels and HBV e antigen(HBeAg)positivity during pregnancy of women with high viral loads of HBV;to assess the association of giving antiviral drugs during pregnancy,in addition to standard care,on the failure rate of prevention of HBV transmission from mother to child.Methods We used the Hospital Information System to collect serological test results and history of antiviral drug use by pregnant women with high HBV-DNA loads(≥2×10^6 IU/mL)for a descriptive analysis of HBV-DNA levels and HBeAg positivity rates.Infants were given hepatitis B immunoglobulin(HBIG)and hepatitis B vaccine(HepB)as newborns.We tested the infants for hepatitis B surface antigen and HBV-DNA at 7 months to 2 years of age-after completing the third dose of HepB-to determine the failure rate for preventing mother-to-child HBV transmission.Results We included 1822 subjects into the study,of which 75.19%had received antiviral therapy and24.81%had not.The proportion of subjects with HBV-DNA≥1.0×10^8 IU/mL during pregnancy and before delivery were68.10%(933/1370)and 0.15%(2/1370),respectively(χ^2=2692.27,p<0.0001).HBeAg positivity rates for subjects who had received antiviral therapy were 96.53%(1001/1037)during pregnancy and 96.16%(1251/1301)before delivery(χ^2=0:237 P=0.635);and for subjects who had not received antiviral therapy were 97.70;(298/305)and 96.98;(417/430)(χ^2=0.36,P=0.550).The failure rates for preventing mother-to-child transmission of HBV to infants in the two groups of subjects were 0.42%(3/714)and 6.67%(14/210),respectively(χ^2=31.69,P<0.0001).Conclusions HBV-DNA levels were greater than 1.0×10^8 IU/mL among most pregnant women with high HBV-DNA loads.Antiviral therapy during pregnancy could significantly reduce HBV-DNA loads and the failure rate of preventing mother-to-child transmission of HBV given in addition to joint administration of HepB and HBIG to newborn infants and administration of two more doses of HepB during infancy.

关 键 词：乙型肝炎 乙型肝炎病毒 高病毒载量 母婴传播阻断 

分 类 号：R186[医药卫生—流行病学]