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
摘要
目的探讨高病毒载量乙型肝炎孕妇抗病毒治疗在阻断乙型肝炎病毒(HBV)母婴传播中的临床效果评价。方法回顾性分析在门诊进行产检并在住院分娩的336例孕妇临床资料,均HBsAg(乙肝表面抗原)阳性,HBV载量≥10~6拷贝/mL,其中实验组152例自孕24周或孕28周开始口服替比夫定片600 mg/d或者富马酸替诺福韦酯二吡呋酯胶囊300 mg/d,直至分娩后停药;另外对照组184例孕期不接受抗病毒治疗。对两组的安全性以及母婴阻断的有效性进行观察。结果实验组孕妇婴儿的早产率及剖宫产的发生率与对照组相比均差异无统计学意义(P>0.05);实验组孕妇抗病毒治疗后HBV-DNA明显下降(P<0.05),并在分娩时维持在很低水平;实验组随访12个月后新生儿HBV感染率为0%,显著低于对照组(感染率为6.52%),差异有统计学意义(P<0.05)。结论高病毒载量乙型肝炎孕妇在合适的孕周选用安全有效的核苷酸类似物进行抗病毒治疗对HBV母婴阻断的作用起着积极的作用,初步研究显示较为安全,可以作为乙肝母婴阻断的一个重要措施。
引文
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[2]Yang D,Liu L,Zhu D,et al.A mouse model for HBV immunotolerance and immunotherapy[J].Cell Mol Immunol,2014,11(1):71-78.
[3]Singh AE,Plitt SS,Osiowy C,et al.Factors associated with vaccine failure and vertical transmission of hepatitis B among a cohort of Canadian mothers and infants[J].J Viral Hepat,2011,18(7):468-473.
[4]Giles ML,Visvanathan K,Lewin SR,et al.Chronic Hepatitis B Infection and Pregnancy[J].Obstet Gynecol Surv,2012,67(1):37-44.
[5]中华医学会妇产科学分会产科学组.乙型肝炎病毒母婴传播预防临床指南[J].中华妇产科杂志,2013,48(2):151-154.
[6]陈川英,涂相林,程全红,等.慢性乙型肝炎患者妊娠早期替比夫定抗病毒的疗效及母婴阻断的临床观察[J].中华肝脏病杂志,2015,23(1):9-12.
[7]王谢桐,于恩燕.妊娠合并乙型病毒性肝炎的母婴传播与阻断[J].中国医药指南,2010,26(4):244-246.
[8]Merle P,Trepo C,Zoulim F.Current management strategies for hepatitis B in the elderly[J].Drugs Aging,2001,18(10):725.
[9]Agarwal AK,Sen S,Banerjee D,et al.Distribution of hepatitis B virus genotype and cancer predicting precore and basal core promoter mutations[J].Med J Armed Forces India,2015,71(3):225-232.
[10]Wong TC,Fung JY,Lo CM.Prevention of recurrent hepatitis B infection after liver transplantation[J].Hepatobiliary Pancreat Dis Int,2013,12(5):465-472.