抗病毒治疗对高病毒载量乙型肝炎孕妇HBV母婴传播的阻断作用及其安全性探讨
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摘要
目的探讨在高病毒载量乙型肝炎孕妇中抗病毒治疗对乙型肝炎病毒(HBV)母婴传播的阻断作用及安全性。方法选取36例高病毒载量乙型肝炎孕妇作为研究对象,均采用替比夫定抗病毒治疗。对比治疗前后乙肝病毒脱氧核糖核酸(HBV-DNA)定量检测结果、肝功能指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血清总胆红素(TBIL)和直接胆红素(DBIL)]变化,统计母婴传播率并观察不良反应。结果治疗前HBV-DNA定量检测结果为(42.61±5.71)×10~5copies/ml,治疗后HBV-DNA定量检测结果为(0.68±0.12)×10~5 copies/ml;治疗后HBV-DNA定量检测结果优于治疗前,差异有统计学意义(t=44.050, P=0.000<0.05)。治疗前ALT、AST、TBIL和DBIL水平分别为(306.85±38.96)U/L、(212.83±29.74)U/L、(63.71±8.75)μmol/L、(28.96±4.77)μmol/L,治疗后ALT、AST、TBIL和DBIL水平分别为(77.02±10.13)U/L、(61.22±9.07)U/L、(24.26±5.08)μmol/L、(6.59±1.52)μmol/L;治疗后ALT、AST、TBIL和DBIL水平均低于治疗前,差异有统计学意义(P<0.05)。36例孕妇均顺利分娩,对新生儿进行检测发现有2例感染HBV, HBV母婴传播率为5.56%(2/36);治疗期间均无肾功能损伤,无消化道不适表现,新生儿未发现畸形。结论对高病毒载量乙型肝炎孕妇采用替比夫定抗病毒治疗能够有效降低病毒载量,改善肝功能,阻断HBV母婴传播,并且安全性高,无明显不良反应。
Objective To discuss the blocking effect and safety of antiviral therapy on mother-to-child transmission of hepatitis B virus(HBV) in pregnant women with high viral load.Methods A total of 36 hepatitis B virus pregnant women with high viral load as study subjects all received tebivudine antiviral therapy. Quantitative detection results of hepatitis B virus deoxyribonucleic acid(HBV-DNA),changes of liver function indexes [alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBIL) and direct bilirubin(DBIL)were compared before and after treatment. Mother-to-child transmission rate was counted and adverse reactions were observed. Results Patients had HBV-DNA quantitative test results as(42.61 ±5.71) × 105 copies/ml before treatment,and(0.68±0.12)×105 copies/ml after treatment.Patients had better HBV-DNA quantitative test results after treatment than that before treatment,and the difference was statistically significant(t=44.050,P=0.000<0.05).Patients had ALT,AST,TBIL and DBIL level respectively as(306.85±38.96)U/L,(212.83±29.74)U/L,(63.71±8.75) μmol/L and(28.96±4.77) μmol/L before treatment, and(77.02± 10.13) U/L,(61.22±9.07) U/L,(24.26±5.08) μmol/L and(6.59±1.52)μmol/L after treatment. Patients had lower ALT, AST, TBIL and DBIL level than those before treatment, and the difference was statistically significant(P<0.05). All the 36 pregnant women gave birth smoothly,and 2 cases were infected with HBV,with mother-to-child transmission rate of HBV as 5.56%(2/36). During the treatment period, there were no renal function damage, no digestive tract discomfort and no malformation in newborns. Conclusion Telbivudine antiviral therapy for pregnant women with high viral load of hepatitis B can effectively reduce viral load,improve liver function,block mother-to-child transmission of HBV,with high safety and no obvious adverse reactions.
Objective To discuss the blocking effect and safety of antiviral therapy on mother-to-child transmission of hepatitis B virus(HBV) in pregnant women with high viral load.Methods A total of 36 hepatitis B virus pregnant women with high viral load as study subjects all received tebivudine antiviral therapy. Quantitative detection results of hepatitis B virus deoxyribonucleic acid(HBV-DNA),changes of liver function indexes [alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBIL) and direct bilirubin(DBIL)were compared before and after treatment. Mother-to-child transmission rate was counted and adverse reactions were observed. Results Patients had HBV-DNA quantitative test results as(42.61 ±5.71) × 105 copies/ml before treatment,and(0.68±0.12)×105 copies/ml after treatment.Patients had better HBV-DNA quantitative test results after treatment than that before treatment,and the difference was statistically significant(t=44.050,P=0.000<0.05).Patients had ALT,AST,TBIL and DBIL level respectively as(306.85±38.96)U/L,(212.83±29.74)U/L,(63.71±8.75) μmol/L and(28.96±4.77) μmol/L before treatment, and(77.02± 10.13) U/L,(61.22±9.07) U/L,(24.26±5.08) μmol/L and(6.59±1.52)μmol/L after treatment. Patients had lower ALT, AST, TBIL and DBIL level than those before treatment, and the difference was statistically significant(P<0.05). All the 36 pregnant women gave birth smoothly,and 2 cases were infected with HBV,with mother-to-child transmission rate of HBV as 5.56%(2/36). During the treatment period, there were no renal function damage, no digestive tract discomfort and no malformation in newborns. Conclusion Telbivudine antiviral therapy for pregnant women with high viral load of hepatitis B can effectively reduce viral load,improve liver function,block mother-to-child transmission of HBV,with high safety and no obvious adverse reactions.
引文
[1]黄海燕,王淼,周建华.不同孕期抗病毒治疗对高HBV-DNA病毒载量孕妇母婴传播阻断免疫效率的影响.中国优生与遗传杂志, 2016, 17(11):72-73.
[2]许喜喜,王斌,王雪飞,等. HBsAg阳性母亲妊娠中晚期服用替比夫定对婴儿乙型肝炎疫苗无/弱应答的影响.中华流行病学杂志, 2017, 38(2):168-172.
[3]曹敏恺,胡玲卿,赵丽.妊娠晚期应用替比夫定阻断乙型肝炎病毒母婴传播的效果.现代医学, 2016, 44(3):292-295.
[4]邱波,朱玲,陈艳,等.妊娠期不同阶段给予替比夫定阻断乙型肝炎病毒宫内母婴传播的研究.实用肝脏病杂志, 2016,19(4):428-431.
[5]陈芳,涂相林,陈川英,等.慢性乙型肝炎患者妊娠全程替比夫定治疗的疗效及母婴阻断的有效性.实用医学杂志, 2016,32(4):636-639.
[6]刘玉娟,蔡秋娥,王淼,等.抗病毒治疗在阻断高病毒载量乙肝孕妇母婴传播中的临床效果.广东医学, 2018, 39(16):93-94, 97.
[7]左丽萍.抗病毒治疗妊娠晚期乙型肝炎在阻断病毒母婴传播中的效果.中国妇幼保健, 2017(12):2600-2602.
[8]刘春燕,高霞,庞秋霞.替比夫定阻断慢性乙肝病毒高载量孕妇母婴传播的临床研究.延安大学学报(医学科学版), 2014,12(4):18-20.
[2]许喜喜,王斌,王雪飞,等. HBsAg阳性母亲妊娠中晚期服用替比夫定对婴儿乙型肝炎疫苗无/弱应答的影响.中华流行病学杂志, 2017, 38(2):168-172.
[3]曹敏恺,胡玲卿,赵丽.妊娠晚期应用替比夫定阻断乙型肝炎病毒母婴传播的效果.现代医学, 2016, 44(3):292-295.
[4]邱波,朱玲,陈艳,等.妊娠期不同阶段给予替比夫定阻断乙型肝炎病毒宫内母婴传播的研究.实用肝脏病杂志, 2016,19(4):428-431.
[5]陈芳,涂相林,陈川英,等.慢性乙型肝炎患者妊娠全程替比夫定治疗的疗效及母婴阻断的有效性.实用医学杂志, 2016,32(4):636-639.
[6]刘玉娟,蔡秋娥,王淼,等.抗病毒治疗在阻断高病毒载量乙肝孕妇母婴传播中的临床效果.广东医学, 2018, 39(16):93-94, 97.
[7]左丽萍.抗病毒治疗妊娠晚期乙型肝炎在阻断病毒母婴传播中的效果.中国妇幼保健, 2017(12):2600-2602.
[8]刘春燕,高霞,庞秋霞.替比夫定阻断慢性乙肝病毒高载量孕妇母婴传播的临床研究.延安大学学报(医学科学版), 2014,12(4):18-20.