高病毒载量HBeAg阳性慢性乙肝孕妇应用抗病毒药物阻断乙型肝炎病毒母婴传播的有效性和安全性分析  

Efficacy and safety of antiviral drugs for blocking mother-to-child transmission of hepatitis B virus(HBV)in pregnant women with high viral load HBeAg positive chronic hepatitis B

作　　者：黄慧慧[1] 陈武玲 朱焕金[1] HUANG Hui-hui;CHEN Wu-ling;ZHU Huan-jin(Department of laboratory,Guangzhou Huadu maternal and Child Health Hospital(Huzhong hospital),Guangzhou 510800,China)

机构地区：[1]广州市花都区妇幼保健院(胡忠医院)检验科,广州510800

出　　处：《中国处方药》2022年第10期146-148,共3页Journal of China Prescription Drug

基　　金：广州市花都区科技和信息化局2019年医疗卫生计划项目(19-HDWS-084)。

摘　　要：目的观察高病毒载量HBeAg阳性慢性乙肝孕妇应用抗病毒药物阻断乙型肝炎病毒(HBV)母婴传播的有效性和安全性分析。方法将收治在院(2020年1月~2020年12月)的高病毒载量HBeAg阳性慢性乙肝孕妇(孕28周),经过纳入、排除筛选后共60例纳入研究,其中30例配合抗病毒药物阻断治疗至分娩后42 d止的孕妇为研究组,另30例未配合抗病毒药物阻断治疗的孕妇为对照组。孕妇的婴儿出生后均接受主、被动联合免疫,并在出生6 h内、1月龄和6月龄时,肌内注射乙肝疫苗各10μg,均于出生后6 h内和1月龄时肌肉注射乙肝免疫球蛋白各200 IU。比较两组孕妇在孕28周和分娩时血清HBV DNA载量,HBV DNA低于检测下限率并统计孕妇不良反应。检测婴儿出生后6 h内(于主、被动免疫前抽股静脉血)和7月龄血清HBsAg阳性率及HBV DNA载量。结果研究组孕妇在分娩时的血清HBV DNA载量明显低于对照组与同组在孕28周时,HBV DNA低于检测下限率高于对照组,差异具有统计学意义(P<0.05)。研究组不良反应率与对照组相比,差异无统计学意义(P>0.05)。出生6 h内,研究组新生儿HBsAg阳性率显著低于对照组,7月龄时,研究组婴儿HBsAg均为阴性,对照组73.33%为阴性,差异具有统计学意义(P<0.05)。研究组婴儿出生及7月龄时血清HBV DNA阳性率均为0.00%,两组婴儿出生后6 h内及7月龄时的HBV DNA阳性率,差异具有统计学意义(P<0.05)。结论分娩前的孕妇血清HBV DNA检查时的载量相对升高,孕妇危险性增加。而在HBV DNA高载量孕妇孕晚期时应用替诺福韦酯抗病毒治疗,可显著降低妊娠晚期孕妇血清HBV DNA载量,提升新生儿的血清HBsAg转阴率,对母婴均具有良好的安全性。Objective To observe the efficacy and safety of antiviral drugs for blocking mother-to-child transmission of hepatitis B virus(HBV)in pregnant women with high viral load HBeAg positive chronic hepatitis B.Methods The high viral load HBeAg positive chronic hepatitis B pregnant women(28 weeks gestation)who were admitted to the hospital(January 2020 to December 2020)were enrolled.After inclusion and exclusion screening,60 cases were included in the study,of which 30 cases were combined with antiviral therapy.Pregnant women who received drug blockade until 42 days after delivery were the study group,and the other 30 pregnant women who did not cooperate with antiviral drug blockade were the control group.Infants of pregnant women received active and passive combined immunization after birth,and intramuscularly injected hepatitis B vaccine with 10μg each within 6 hours,1 month and 6 months of age,both within 6 hours and 1 month after birth.Intramuscular injection of 200 IU of hepatitis B immune globulin.The serum HBV DNA load of pregnant women at 28 weeks of gestation and delivery was compared between the two groups.The serum HBsAg positive rate and HBV DNA load were detected within 6 hours after birth(femoral venous blood was drawn before active and passive immunization)and at 7 months of age.Results The serum HBV DNA load of pregnant women in the study group at delivery was significantly lower than that in the control group and the same group at 28 weeks of gestation.There was no significant difference in the adverse reaction rate between the study group and the control group(P>0.05).Within 6 hours of birth,the positive rate of HBsAg in the study group was significantly lower than that in the control group.At the age of 7 months,all the infants in the study group were negative for HBsAg,while 73.33% in the control group were negative,and the difference was statistically significant(P<0.05).The positive rates of serum HBV DNA at birth and at 7 months of age in the study group were both 0.00%,and the differences in th

关 键 词：高病毒载量 HBEAG阳性 慢性乙肝孕妇 抗病毒药物 阻断治疗 乙型肝炎病毒(HBV) 母婴传播 有效性 安全性 

分 类 号：R714.251[医药卫生—妇产科学]