LAM联合HBIG在HBV母婴传播中的阻断效果及安全性  

Blocking Effect and Safety of LAM Combined with HBIG in Mother-to-child Transmission of HBV

作　　者：李玲玲 毛玉萍[1] 周莹 LI Lingling;MAO Yuping;ZHOU Ying(Luoding People's Hospital,Luoding 527200,China;不详)

机构地区：[1]麻城市人民医院,湖北麻城438300

出　　处：《中外医学研究》2023年第4期43-48,共6页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:研究拉米夫定(Lamivudine,LAM)联合乙型肝炎免疫球蛋白(hepatitis B immunoglobulin,HBIG)对乙型肝炎病毒(hepatitis B virus,HBV)母婴传播的阻断效果及安全性。方法:回顾性选取2017年12月—2019年12月麻城市人民医院105例HBV感染孕妇为样本。根据治疗方案不同将其分为联合组(n=74)和LAM组(n=31)。LAM组接受LAM治疗,联合组接受LAM联合HBIG治疗。比较两组治疗前及临产前HBV标志物(HBVM)水平、HBV-DNA载量、肝功能指标,新生儿健康情况,新生儿HBV感染情况。分析药物安全性。结果:临产前,两组HBcAb、HBeAg及HBV-DNA水平均明显降低(P<0.05),且联合组HBeAg和HBV-DNA水平均低于LAM组(P<0.05)。临产前,两组谷丙转氨酶(ALT)、谷草转氨酶(AST)及总胆红素(TBIL)水平均明显升高(P<0.05),两组ALT、AST及TBIL水平比较差异均无统计学意义(P>0.05)。两组新生儿体重、10 min Apgar评分及新生儿肺炎、窒息和畸形发生率比较差异均无统计学意义(P>0.05)。接种疫苗前,联合组新生儿HBsAg阳性率低于LAM组(P<0.05),接种疫苗后1个月,两组HBsAg阳性率均明显降低,两组HBs Ag和抗-HBs阳性率比较差异均无统计学意义(P>0.05)。治疗期间,联合组孕妇发生一过性ALT水平轻度升高1例(1.89%),新生儿黄疸1例(1.89%),肌酸激酶升高2例(3.77%);LAM组孕妇未见明显异常,新生儿发生高胆红素血症1例(1.89%),均未予特殊处理,观察1周后自行恢复正常。结论:LAM联合HBIG阻断HBV母婴垂直传播可有效降低孕妇血液中病毒滴度和复制水平,降低新生儿宫内感染风险。Objective: To study the blocking effect and safety of Lamivudine(LAM) combined with hepatitis B immunoglobulin(HBIG) in mother-to-child transmission of hepatitis B virus(HBV). Method: A total of 105 pregnant women with HBV infection in Macheng People’s Hospital from December 2017 to December 2019 were retrospectively selected as samples. They were divided into combination group(n=74) and LAM group(n=31) according to different treatment programme. The LAM group received LAM treatment,and the combination group received LAM combined with HBIG treatment. The HBV marker(HBVM) level, HBV-DNA load, liver function indexes before treatment and before labor, neonatal health status and neonatal HBV infection status were compared between the two groups. The drug safety was analyzed. Result: Before labor, the levels of HBcAb, HBeAg and HBV-DNA in the two groups were significantly decreased(P<0.05), and the levels of HBeAg and HBV-DNA in the combination group were lower than those in the LAM group(P<0.05). Before labor, the levels of glutamic-pyruvic transaminase(ALT), glutamic-oxaloacetic transaminase(AST), total bilirubin(TBIL) in the two groups were significantly increased(P<0.05), and there were no significant differences in the levels of ALT, AST and TBIL between the two groups(P>0.05). There were no significant differences in neonatal weight, Apgar score at 10 min and incidences of neonatal pneumonia, asphyxia and malformation between the two groups(P>0.05). Before vaccination, the positive rate of HBsAg in the combination group was lower than that in the LAM group(P<0.05). One month after vaccination, the positive rate of HBsAg in the newborn of two groups decreased significantly, and there were no significant differences in the positive rates of HBsAg and anti-HBs between the newborn of two groups(P>0.05). During the treatment period, there was 1 case(1.89%) of transient mild elevation of ALT level in pregnant women, 1 case(1.89%) of neonatal jaundice, and 2 cases(3.77%) of creatine kinase elevation in the combinatio

关 键 词：乙肝病毒 母婴传播 宫内感染 阻断 拉米夫定 乙肝肝炎免疫球蛋白 

分 类 号：R714.251[医药卫生—妇产科学]