应用替比夫定和替诺福韦治疗阻断血清HBV DNA高载量孕妇母婴传播的效果分析*

doi:10.3969/j.issn.1672-5069.2020.06.012

摘要/Abstract

摘要： 目的比较应用替比夫定(LdT)和替诺福韦(TDF)治疗血清乙型肝炎病毒(HBV)脱氧核糖核酸(DNA)高载量孕妇,阻断病毒母婴传播的疗效。方法 2017年7月~2019年6月我科诊治的血清HBV DNA高载量(＞1×10⁶ IU/mL)孕妇85例,随机分为两组,分别在孕28周时接受LdT治疗(n=43)或TDF治疗(n=42)至分娩结束。新生儿出生时规范接受乙肝疫苗和人乙型肝炎病毒免疫球蛋白接种,新生儿或婴儿血清HBV DNA＞5×10²copies/mL或HBsAg阳性,视为HBV感染。结果在分娩结束时,LdT治疗组妇女血清HBV DNA和HBeAg水平分别为(2.9±0.6)lg IU/mL和(939.5±286.6)S/CO,与TDF治疗组的【(3.1±0.7)lg IU/mL和(940.7±285.6)S/CO,P>0.05】比,无显著差异,两组血清HBsAg、ALT和AST水平均无显著变化; LdT治疗组妇女所生新生儿出生胎龄为(39.4±1.2)w,身长为(50.9±2.8)cm,头围为(33.8±1.3)cm,体质量为(3087.9±471.5)g,Apgar评分为(9.5±0.4)分,与TDF治疗组比,差异无统计学意义【分别为(39.6±1.1)w、(51.2±3.1)cm、(33.9±1.5)cm、(3112.9±464.9)g和(9.6±0.6)分,P>0.05】;随访婴儿至12个月,两组分别有1例(2.3%对2.4%)幼儿发生HBV感染。结论应用LdT或TDF治疗孕晚期血清高HBV DNA载量的乙型肝炎病毒携带孕妇均可阻断HBV母婴传播,效果肯定,值得临床开展大规模研究。

关键词: 乙型肝炎病毒携带者, 妊娠, 替比夫定, 替诺福韦, 母婴传播

Abstract: Objective The aim of this study was to compare the efficacy of telbivudine (LdT) and tenofovir disoproxil fumarate (TDF) in blocking hepatitis B viral transmission from mother to infant in pregnant women with high serum hepatitis B virus (HBV) deoxyribonucleic acid (DNA) loads. Methods 85 pregnant female HBV carriers with serum HBV DNA >1×10⁶IU/mL were recruited in this study, and randomly divided into two groups, receiving LdT (n=43) or TDF (n=42) at gestational 28 weeks. The antiviral regimen lasted to the delivery. Serum HBV DNA and/or HBsAg positive were defined as HBV infection. Results At the delivery, serum HBV DNA load and HBeAg level in LdT-treated women were (2.9±0.6)lg IU/mL and (939.5±286.6)S/CO, both not significantly different compared to 【(3.1±0.7)lg IU/mL and (940.7±285.6)S/CO, respectively, P>0.05】 in TDF-treated women, and serum HBsAg, ALT and AST levels in the two groups were not much different (P>0.05); in LdT group, the infant's gestational age was (39.4±1.2)w, the height was (50.9±2.8)cm, the head circumference was(33.8±1.3)cm, the body mass was (3087.9±471.5)g and the Apgar score at one minute was(9.5±0.4), all not significantly different compared to【(39.6±1.1)w, (51.2±3.1)cm, (33.9±1.5)cm, (3112.9±464.9)g and (9.6±0.6), respectively, P>0.05】 in TDF group; the infant's HBV infection was 2.3% vs. 2.4% in the two groups (P>0.05). Conclusion Both LdT and TDF could be orally given to pregnant women with high serum HBV DNA loads at gestation of greater than 28 weeks to block mother-to-child HBV transmission, and worth further clinical investigation.

Key words: Hepatitis B viral carriers, Pregnancy, Mother-to-child transmission, Telbivudine, Tenofovir disoproxil fumarate

周娟, 刘月合, 王春佟. 应用替比夫定和替诺福韦治疗阻断血清HBV DNA高载量孕妇母婴传播的效果分析^*[J]. 实用肝脏病杂志, 2020, 23(6): 805-808.

Zhou Juan, Liu Yuehe, Wang Chuntong. Efficacy of telbivudine and tenofovir in blocking mother-to-infant transmission of hepatitis B virus in pregnant women with high serum HBV DNA loads[J]. Journal of Practical Hepatology, 2020, 23(6): 805-808.

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应用替比夫定和替诺福韦治疗阻断血清HBV DNA高载量孕妇母婴传播的效果分析^*

Efficacy of telbivudine and tenofovir in blocking mother-to-infant transmission of hepatitis B virus in pregnant women with high serum HBV DNA loads

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