妊娠中晚期应用替比夫定阻断HBsAg阳性孕妇HBV母婴传播效果及对婴儿接种乙肝疫苗应答的影响*

doi:10.3969/j.issn.1672-5069.2019.01.014

实用肝脏病杂志 ›› 2019, Vol. 22 ›› Issue (1): 49-52.doi: 10.3969/j.issn.1672-5069.2019.01.014

妊娠中晚期应用替比夫定阻断HBsAg阳性孕妇HBV母婴传播效果及对婴儿接种乙肝疫苗应答的影响^*

谭静, 叶晓林, 王慧

246000安徽省安庆市广东医科大学附属安庆市第一人民医院妇产科（谭静,叶晓林）; 感染病科（王慧）

收稿日期:2018-09-05 出版日期:2019-01-10 发布日期:2019-01-16
作者简介:谭静,女,36岁,大学本科,主治医师。E-mail:2058854116@qq.com
基金资助:
*安徽省自然科学基金资助项目（编号：523621）

Efficacy of telbivudine in blocking mother-to-child transmission of hepatitis B virus infection in pregnant women with serum HBsAg positive and its influence on infant’s response to hepatitis B vaccination

Tan Jing, Ye Xiaolin, Wang Hui.

Department of Obstetrics and Gynecology, First People's Hospital, Affiliated to Guangdong Medical University, Anqing 246000, Anhui Province,China

Received:2018-09-05 Online:2019-01-10 Published:2019-01-16

摘要/Abstract

摘要： 目的观察应用替比夫定治疗HBsAg阳性妊娠中晚期孕妇阻断HBV母婴传播的效果及其对婴儿接种乙肝疫苗应答的影响。方法 2013年7月~2015年12月我院接诊的100例HBsAg阳性孕妇和100例她们的新生儿,41例孕妇妊娠28周开始服用替比夫定,另59例未接受抗病毒治疗。对新生儿行标准乙肝疫苗全程接种,并随访至12月龄。采用ELISA法检测血清IFN-γ和IL-10水平。应用Logistic回归分析影响婴儿对乙肝疫苗接种应答的因素。结果抗病毒组孕妇分娩后血清HBV DNA载量为（2.0±1.3） lg IU/ml,显著低于未抗病毒组【（7.1±1.6）lg IU/ml,P<0.05】;抗病毒组剖宫产、早产、产后出血和新生儿窒息发生分别为29.3%、12.2%、4.9%和9.8%,与未抗病毒组的30.5%、11.9%、5.1%和8.5%比,差异无统计学意义（P>0.05）;在出生后随访1年,在41例抗病毒组孕妇分娩的婴儿中无一例血清HBsAg呈阳性,而在59例未抗病毒组婴儿中6例（10.2%）血清HBsAg阳性（x²=4.436,P=0.035）;50例血清IFN-γ和IL-10高水平组婴儿对乙肝疫苗接种强应答发生率显著增高（P<0.05）;Logistic回归分析发现新生儿血清IFN-γ和IL-10高水平是婴儿对乙肝疫苗接种强应答的保护因素。结论在妊娠中晚期服用替比夫定可以阻断血清HBsAg阳性母亲HBV母婴传播,且对乙肝疫苗接种应答无明显影响,检测新生儿血清IFN-γ和IL-10水平有助于判断乙肝疫苗接种应答结果,而对可能弱或低水平应答者早期做出补种计划。

关键词: 乙型肝炎病毒携带者, 替比夫定, 妊娠, 乙肝疫苗, 母婴传播

Abstract: Objective To study the efficacy of telbivudine in blocking mother-to-child transmission of hepatitis B virus infection in pregnant women with serum HBsAg positive and its influence on infant’s response to hepatitis B vaccination. Methods 100 pregnant women with serum HBsAg positive and their 100 newborns were enrolled in our hospital between July 2013 and July 2015,41 out of the pregnant women took telbivudine at 28 week gestation,and 59 didn’t. All newborns were fully vaccinated with hepatitis B vaccine. They were followed-up for 12 months. Serum HBV markers and HBV DNA loads were measured by electrochemical luminescence and serum IFN-γ and IL-10 levels were detected by ELISA. Logistic multivariate regression analysis was used to analyze the facters affecting the response of infants to hepatitis B vaccination. Results Serum HBV DNA load in women receiving antiviral therapy after dilivery was（2.0±1.3） lg IU/ml,significantly lower than 【（7.1±1.6） lg IU/ml,P<0.05】 in women who didn’t receive antiviral therapy;the incidences of cesarean section,premature delivery,postpartum hemorrhage and neonatal asphyxia in women receiving antiviral treatment were 29.3%,12.2%,4.9% and 9.8%,all not significantly different compared with 30.5%,11.9%,5.1% and 8.5%,respectively,in women who didn’t receive antiviral therapy （P>0.05）;at the end of 12-month followed-up,no infant in 41 mothers receiving antiviral therapy was serum HbsAg positive,while six（10.2%） in 59 mothers without antiviral therapy were serum HbsAg positive（x²=4.436,P=0.035）;the strong response rates in 50 infants with high serum IFN-γ and IL-10 levels were much higher than those with lower serum cytokine levels（P<0.05）;Logistic regression analysis showed that high serum IFN-γ and IL-10 levels were the independent factors affecting infants’response to hepatitis B vaccination. Conclusion The application of telbivudine at late gestational stage might block the HBV mother-to-infant transmission in women with serum HbsAg positive,and the detection of serum IFN-γ and IL-10 levels might predict the response of infants’ response to hepatitis B vaccination.

Key words: HbsAg carriers, Telbivudine, Hepatitis B vaccine, Pregnancy, Mother-to-infant trasmission

谭静, 叶晓林, 王慧. 妊娠中晚期应用替比夫定阻断HBsAg阳性孕妇HBV母婴传播效果及对婴儿接种乙肝疫苗应答的影响^*[J]. 实用肝脏病杂志, 2019, 22(1): 49-52.

Tan Jing, Ye Xiaolin, Wang Hui.. Efficacy of telbivudine in blocking mother-to-child transmission of hepatitis B virus infection in pregnant women with serum HBsAg positive and its influence on infant’s response to hepatitis B vaccination[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(1): 49-52.

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妊娠中晚期应用替比夫定阻断HBsAg阳性孕妇HBV母婴传播效果及对婴儿接种乙肝疫苗应答的影响^*

Efficacy of telbivudine in blocking mother-to-child transmission of hepatitis B virus infection in pregnant women with serum HBsAg positive and its influence on infant’s response to hepatitis B vaccination

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