乙肝病毒母婴阻断策略中替比夫定的疗效和安全性

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英文篇名：Efficacy and Safety of Telbivudine for the Prevention of Mother-to-Child Transmission of Hepatitis B Virus 作者：那妍 ; 娄宪芝 ; 张晓旭 ; 姜镔 英文作者：NA Yan;LOU Xianzhi;ZHANG Xiaoxu;JIANG Bin;Department of Infectious Disease,The Affiliated Central Hospital of Shenyang Medical College;Department of Ultrasound,The First Hospital,China Medical University; 关键词：替比夫定 ; 乙肝高病毒载量孕妇 ; 母婴阻断 英文关键词：telbivudine;;pregnant women with high hepatitis B viral load;;prevention of mother-to-child transmission 中文刊名：ZGYK 英文刊名：Journal of China Medical University 机构：沈阳医学院附属中心医院感染科;中国医科大学附属第一医院超声科; 出版日期：2019-05-13 10:37 出版单位：中国医科大学学报 年：2019 期：v.48;No.335 基金：辽宁省自然科学基金(20170540882);; 沈阳市科技计划(17-230-9-81) 语种：中文; 页：ZGYK201905004 页数：4 CN：05 ISSN：21-1227/R 分类号：20-23

摘要

目的给予孕28周乙肝高病毒载量孕妇口服替比夫定抗病毒治疗,观察其疗效及安全性,探讨更优化的乙肝母婴阻断策略。方法选择70例乙肝高病毒载量孕妇,分别在中孕晚期接受口服替比夫定抗病毒治疗联合新生儿出生后主、被动免疫的母婴阻断策略(实验组,n=50)或仅进行新生儿主、被动免疫的母婴阻断策略(对照组,n=20),比较2组孕妇孕32周和分娩前乙肝病毒DNA (HBV-DNA)、丙氨酸转氨酶(ALT)、肌酐(Crea)、肌酸激酶同工酶(CK-MB)、凝血酶原时间(PT)、宫高、腹围、胎心指标是否存在差异,比较2组胎儿出生时Apgar评分以及出生后7个月时乙型肝炎表面抗原是否存在差异。结果 2组孕妇在孕32周及分娩前HBV-DNA的差异有统计学意义(P <0.05);2组婴儿母婴阻断失败率的差异无统计学意义(P> 0.05)。2组孕妇在孕32周和分娩前ALT、Crea、CK-MB、PT的差异无统计学意义(P> 0.05);2组孕妇在孕32周和分娩前腹围、宫高、胎心的差异无统计学意义(P> 0.05);2组新生儿出生后Apgar评分的差异无统计学意义(P> 0.05)。结论孕28周时对乙肝高病毒载量孕妇进行替比夫定抗病毒治疗,可降低乙肝母婴阻断失败率,具有良好的疗效及安全性,为更优化的母婴阻断策略。
        Objective To evaluate the efficacy and safety of telbivudine for the prevention of mother-to-child transmission(MTCT) of hepatitis B virus(HBV) in women with high hepatitis B viral load. Methods We conducted a prospective study with telbivudine in pregnant women with high hepatitis B viral load,and compared the following parameters,namely,maternal HBV-DNA,alanine aminotransferase(ALT),creatinine(Crea),creatine kinase-MB(CK-MB),prothrombin time(PT),fundal height,abdominal circumference,and fetal heart rate between the experimental and control groups at baseline,32 weeks of gestation,and antepartum. The fetal Apgar score at birth and the fetal HBV-DNA level and hepatitis B surface antigen after seven months of birth were also compared between the two groups.Results There was a significant difference in the maternal HBV-DNA level at 32 weeks of gestation and at antepartum between the two groups(P < 0.05). No difference in the failure rate of preventing HBV MTCT was found between the two groups(P > 0.05). No significant differences in the maternal ALT,Crea,CK-MB,PT,fundal height,abdominal circumference,and fetal heart rate were detected between the two groups at 32 weeks of gestation and at antepartum. There was no significant difference in the fetal Apgar score between the two groups.Conclusion In pregnant women with a high hepatitis B viral load,telbivudine is effective and safe in reducing HBV MTCT. Telbivudine rarely induces off-treatment hepatitis flare.

引文

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