替比夫定对乙肝患者妊娠结局及降低新生儿乙肝感染率的影响
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摘要
目的探索替比夫定(telbivudine,LdT)抗病毒治疗对乙肝患者妊娠结局及降低新生儿乙肝感染率的影响。方法回顾性分析北京佑安医院2016年1月至2018年1月诊断明确的妊娠合并慢乙肝患者,按照病毒量高低分为高病毒载量组(A组)及低病毒载量组(B组),并将A组根据孕晚期是否行LdT抗病毒分为抗病毒治疗组(A1组)及未抗病毒治疗组(A2组)。分别对比A组与B组患者一般资料及妊娠结局;进一步对比分析A1组与A2组、A1组与B组一般资料及妊娠结局、孕期乙肝病毒载量变化及新生儿乙肝感染率。结果 (1)A组妊娠期高血压疾病、产后出血发生率明显高于B组。A1组妊娠期高血压疾病、肝内胆汁淤积症、早产及产后出血发生率明显低于A2组。(2)A1组抗病毒治疗后1个月及2个月血清HBV-DNA<1.0×10~4 IU/ml发生率高于A2组,但明显低于B组;分娩前血清HBV-DNA<1.0×10~4 IU/ml发生率明显高于A2组;(3)A1组产时污染率低于A2组。A1组及B组无一例出现新生儿宫内感染及免疫失败。结论替比夫定可改善乙肝患者不良妊娠结局,降低新生儿乙肝感染发生率。
Objective To investigate antiviral therapy of Telbivudine(LdT) on pregnant outcomes and reduce the neonatal infection rate of hepatitis B patients. Methods A retrospective study was performed of all pregnancies in hepatitis B patients managed at the Beijing Youan Hospital from January 2016 to 2018.Patients were divided into high viral load group(Group A) and low viral load group(Group B) according to the level of Hepatitis B virus(HBV). Group A was then divided into antiviral treatment group(Group A1) and no antiviral treatment group(Group A2) according to whether LdT was used during third trimester of pregnancy. Clinical data and pregnant outcomes were compared between Group A and B.Then clinical data, pregnant outcomes, HBV-DNA viral load and neonatal HBV infection rate were compared between Group A1 and A2, Group A1 and B separately. Results (1) The rate of hypertensive disorder complicating pregnancy(HDCP) and postpartum hemorrhage in Group A were higher than that in Group B. The occurrence of HDCP, intrahepatic cholestasis、premature birth and postpartum hemorrhage in Group A1 were significantly lower than that in Group A2. (2) In Group A1,the frequencies of HBV-DNA viral load less than 1.0×10~4 IU/ml after antiviral treatment 1 and 2 month were both lower than that in Group B. In Group A1 the frequencies of HBV-DNA viral load less than 1.0×10~4 IU/ml before delivery was higher than that in Group A2. (3) The contamination rate of HBV during delivery in Group A1 was lower than that in Group A2. No cases of intrauterine infection and immunization failure occurred in Group A1 and B. Conclusion Antiviral therapy of LdT can improve adverse pregnant outcomes and reduce neonatal infection rate in HBV patients.
Objective To investigate antiviral therapy of Telbivudine(LdT) on pregnant outcomes and reduce the neonatal infection rate of hepatitis B patients. Methods A retrospective study was performed of all pregnancies in hepatitis B patients managed at the Beijing Youan Hospital from January 2016 to 2018.Patients were divided into high viral load group(Group A) and low viral load group(Group B) according to the level of Hepatitis B virus(HBV). Group A was then divided into antiviral treatment group(Group A1) and no antiviral treatment group(Group A2) according to whether LdT was used during third trimester of pregnancy. Clinical data and pregnant outcomes were compared between Group A and B.Then clinical data, pregnant outcomes, HBV-DNA viral load and neonatal HBV infection rate were compared between Group A1 and A2, Group A1 and B separately. Results (1) The rate of hypertensive disorder complicating pregnancy(HDCP) and postpartum hemorrhage in Group A were higher than that in Group B. The occurrence of HDCP, intrahepatic cholestasis、premature birth and postpartum hemorrhage in Group A1 were significantly lower than that in Group A2. (2) In Group A1,the frequencies of HBV-DNA viral load less than 1.0×10~4 IU/ml after antiviral treatment 1 and 2 month were both lower than that in Group B. In Group A1 the frequencies of HBV-DNA viral load less than 1.0×10~4 IU/ml before delivery was higher than that in Group A2. (3) The contamination rate of HBV during delivery in Group A1 was lower than that in Group A2. No cases of intrauterine infection and immunization failure occurred in Group A1 and B. Conclusion Antiviral therapy of LdT can improve adverse pregnant outcomes and reduce neonatal infection rate in HBV patients.
引文
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[3]Gentile I,Borgia G.Vertical transmission of hepatitis B virus:challenges and solutions[J].Int J Womens Health,2014,6(1):605-611.
[4]Hua Zhang,Calvin Q.Pan,Qiumei Pang,et al.Telbivudine or Lamivudine Use in Late Pregnancy Safely Reduces Perinatal Transmission of Hepatitis B Virus in Real-Life Practice[J].Hepatology,2014,60(2):468-476.
[5]周明芳,李晔,王伊龙.妊娠期ICP患者合并HBV感染对妊娠结局的影响[J].临床和实验医学杂志,2014,13(21):1762-1764.
[6]陈君,孙晓风.妊娠晚期应用替比夫定阻断乙型肝炎病毒宫内感染疗效和安全性的系统评价[J],实用肝脏病杂志,2014,17(3):249-254.
[7]胆汁淤积性肝病诊断治疗专家共识2015年更新专家委员会.胆汁淤积性肝病诊断治疗专家共识:2015年更新[J/CD].中国肝脏病杂志(电子版),2015,7(2):1-11.
[8]崔祖丽.替比夫定对妊娠合并慢性乙型肝炎患者肝功能及妊娠结局的影响[J].国际医药卫生导报,2015,21(21):3202-3204.
[9]Romero R,Dey SK,Fisher SJ.Preterm labor:one syndrome,many causes[J].Science,2014,345(6198):760-765.
[10]Terrault NA,Bzowej NH,Chang KM,et al.AASLD guidelines for treatment of chronic hepatitis B[J].Hepatology,2016,63(1):261-283.
[11]Chen ZX,Gu GF,Bian ZL,et al.Clinical course and perinatal transmission of chronic hepatitis B during pregnancy:A real-world prospective cohort study[J].J Infect,2017,75(2):146-154.
[2]中华医学会肝病学分会,中华医学会感染病学分会.慢性乙型肝炎防治指南(2015年版)[J].中华实验和临床感染病杂志,2015,9(5):570-584.
[3]Gentile I,Borgia G.Vertical transmission of hepatitis B virus:challenges and solutions[J].Int J Womens Health,2014,6(1):605-611.
[4]Hua Zhang,Calvin Q.Pan,Qiumei Pang,et al.Telbivudine or Lamivudine Use in Late Pregnancy Safely Reduces Perinatal Transmission of Hepatitis B Virus in Real-Life Practice[J].Hepatology,2014,60(2):468-476.
[5]周明芳,李晔,王伊龙.妊娠期ICP患者合并HBV感染对妊娠结局的影响[J].临床和实验医学杂志,2014,13(21):1762-1764.
[6]陈君,孙晓风.妊娠晚期应用替比夫定阻断乙型肝炎病毒宫内感染疗效和安全性的系统评价[J],实用肝脏病杂志,2014,17(3):249-254.
[7]胆汁淤积性肝病诊断治疗专家共识2015年更新专家委员会.胆汁淤积性肝病诊断治疗专家共识:2015年更新[J/CD].中国肝脏病杂志(电子版),2015,7(2):1-11.
[8]崔祖丽.替比夫定对妊娠合并慢性乙型肝炎患者肝功能及妊娠结局的影响[J].国际医药卫生导报,2015,21(21):3202-3204.
[9]Romero R,Dey SK,Fisher SJ.Preterm labor:one syndrome,many causes[J].Science,2014,345(6198):760-765.
[10]Terrault NA,Bzowej NH,Chang KM,et al.AASLD guidelines for treatment of chronic hepatitis B[J].Hepatology,2016,63(1):261-283.
[11]Chen ZX,Gu GF,Bian ZL,et al.Clinical course and perinatal transmission of chronic hepatitis B during pregnancy:A real-world prospective cohort study[J].J Infect,2017,75(2):146-154.