乙型肝炎人免疫球蛋白联合替诺福韦对妊娠合并慢性乙型肝炎患者的治疗效果研究  

Clinical Efficacy of Human Hepatitis B Immunoglobulin Combined with Tenofovir in the Treatment of Patients with Pregnancy Complicated with Chronic Hepatitis B

作　　者：刘晓红[1] 张雅[1] 韩曦 LIU Xiaohong;ZHANG Ya;HAN Xi(Dept.of Obstetrics,Shaanxi Provincial People’s Hospital,Shaanxi Xi’an 710068,China)

机构地区：[1]陕西省人民医院产科,陕西西安710068

出　　处：《中国医院用药评价与分析》2021年第5期526-529,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：陕西省自然科学基础研究计划项目(No.2020JQ-937)。

摘　　要：目的:探讨乙型肝炎人免疫球蛋白联合替诺福韦对妊娠合并慢性乙型肝炎患者的治疗效果。方法:选取2017年4月至2020年4月于陕西省人民医院接受治疗的妊娠合并慢性乙型肝炎患者90例,采用随机数字表法分为替诺福韦组、联合组,每组45例。替诺福韦组患者采用替诺福韦治疗,联合组患者采用乙型肝炎人免疫球蛋白联合替诺福韦治疗。检测两组患者的乙型肝炎病毒(hepatitis B virus,HBV)DNA、T淋巴细胞亚群水平,以酶标分析仪检测两组患者的丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)水平,统计对比两组患者的ALT复常率、HBV DNA转阴率、新生儿乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)阳性率、乙型肝炎表面抗体(hepatitis B surface antibody,HBsAb)阳性率以及母婴阻断成功率,以免疫透射比浊法检测新生儿免疫球蛋白(Ig)A、IgM和IgG水平。结果:治疗后,与替诺福韦组比较,联合组患者的HBV DNA、ALT及AST水平明显较低,差异均有统计学意义(P<0.05)。治疗后,与替诺福韦组比较,联合组患者的CD8^(+)水平明显较低,CD4^(+)、CD3^(+)水平明显较高,差异均有统计学意义(P<0.05)。与替诺福韦组比较,联合组患者的ALT复常率、HBV DNA转阴率及阻断成功率明显较高,差异均有统计学意义(P<0.05)。与替诺福韦组比较,联合组新生儿的HBsAg阳性率、HBsAb阳性率明显较低,IgA、IgM及IgG水平明显较低,差异均有统计学意义(P<0.05)。结论:采用乙型肝炎人免疫球蛋白联合替诺福韦对妊娠合并慢性乙型肝炎患者进行治疗,能够调控HBV DNA水平,改善患者肝功能、免疫功能,提高患者的ALT复常率、HBV DNA转阴率,降低新生儿HBsAg阳性率、HBsAb阳性率,改善新生儿免疫功能,母婴阻断效果显著。OBJECTIVE:To explore the clinical efficacy of human hepatitis B immunoglobulin combined with tenofovir in the treatment of patients with pregnancy complicated with chronic hepatitis B.METHODS:Totally 90 patients with pregnancy complicated with chronic hepatitis B admitted into Shaanxi Provincial People’s Hospital from Apr.2017 to Apr.2020 were extracted to be divided into the tenofovir group and the combination group via the random number table,with 45 cases in each group.The tenofovir group was treated with tenofovir,while the combination group received human hepatitis B immunoglobulin combined with tenofovir.The levels of hepatitis B virus(HBV)DNA and T lymphocyte subsets were detected in two groups.The levels of alanine aminotransferase(ALT)and aspartate aminotransferase(AST)were measured by enzyme-linked immunosorbent assay.The normalization rate of ALT,negative rate of HBV DNA,positive rate of hepatitis B surface antigen(HBsAg),positive rate of hepatitis B surface antibody(HBsAb)and success rate of blockade of mother-to-child transmission were compared between two groups.The levels of immunoglobulin(Ig)A,IgM and IgG in neonates were determined by immunoturbidimetric method.RESULTS:After treatment,compared with the tenofovir group,the levels of HBV DNA,ALT and AST in the combination group were significantly lower,and the differences were statistically significant(P<0.05).After treatment,compared with the tenofovir group,the levels of CD8^(+) in the combination group were significantly lower,while the levels of CD4^(+) and CD3^(+) were significantly higher,with statistically significant difference(P<0.05).Compared with the tenofovir group,the normalization rate of ALT,negative rate of HBV DNA and success rate of blockade of mother-to-child transmission in the combination group were significantly higher,and the differences were statistically significant(P<0.05).Compared with the tenofovir group,the positive rate of HBsAg,positive rate of HBsAb of neonates in the combination group were significantly lower,and

关 键 词：妊娠 慢性乙型肝炎 乙型肝炎人免疫球蛋白 替诺福韦 母婴阻断 肝功能 

分 类 号：R975[医药卫生—药品]