替诺福韦联合主被动免疫阻断高血清乙型肝炎病毒载量孕妇母婴传播效果研究*

doi:10.3969/j.issn.1672-5069.2023.02.007

摘要/Abstract

摘要： 目的探讨应用替诺福韦联合人乙型肝炎免疫球蛋白(HBIG)和乙肝疫苗接种阻断高血清乙型肝炎病毒(HBV)载量孕妇母婴传播(MTCT)的效果。方法 2019年4月～2022年2月淮安市第四人民医院诊治的109例高血清HBV载量孕妇被分为对照组55例和观察组54例,分别给予HBIG联合乙肝疫苗接种或在此基础上,在孕28周给予孕妇替诺福韦口服至分娩干预。随访,记录妊娠不良结局,并于新生儿出生7个月时评估阻断MTCT的效果。常规检测血清HBV标记物、血生化和HBV DNA。结果两组孕妇年龄、孕周、孕次和产次比较,无统计学差异(P>0.05);在分娩时,观察组血清HBV DNA载量为(0.8±0.8)lgIU/mL,显著低于对照组【(7.8±1.1)lgIU/mL,P＜0.05】,而两组血清ALT水平分别为(41.5±6.4)U/L和(43.6±7.0)U/L,无统计学差异(P>0.05);在随访时,观察组新生儿血清HBsAg、HBeAg和HBV DNA全阴性,而对照组则分别有5例、4例和4例阳性,阻断失败率为12.7%,显著高于观察组(P＜0.05)。结论应用替诺福韦联合HBIG和乙肝疫苗主被动免疫能有效阻断血清高HBV载量孕妇MTCT,无严重不良反应或妊娠不良结局发生,值得进一步研究。

关键词: 乙型肝炎病毒携带者, 母婴传播, 乙型肝炎免疫球蛋白, 乙肝疫苗, 阻断, 孕妇

Abstract: Objective The aim of this study was to observe the blocking effect of mother-to-child transmission (MTCT) of hepatitis B virus (HBV) in pregnant women with high serum HBV loads by oral tenofovir, and human hepatitis B immunoglobulin (HBIG)and hepatitis B vaccine (HBVac) combination immunization in fetus. Methods A total of 109 pregnant women with high serum viral load of hepatitis B virus were encountered in the Fourth People's Hospital, Huai'an City, Jiangsu Province between April 2019 and February 2022, and were divided into control (n=55) and observation group (n=54). The fetus in the control group were treated with HBIG and HBVac immunization immediately after birth, and those in the observation group got the same immunization, and their mothers took tenofovir orally at gestation of 28 weeks until delivery. The mothers and fetuses were carefully followed-up for 7 months. Serum biochemical parameters, HBV markers and HBV DNA loads were routinelymonitored. The untoward pregnancy outcomes of neonates were recorded. Results At inclusion, there were no significant differences as respect to ages, gestation, pregnancy times and birth times in the two groups(P>0.05); at birth, serum HBV DNA load in the observation women was (0.8±0.8)lgIU/mL, significantly lower than [(7.8±1.1)lgIU/mL, P＜0.05] in the control, while there was no significant difference respect to serum ALT levels in the two groups [(41.5±6.4)U/L vs. (43.6±7.0)U/L, P>0.05); at the end of seven month follow-up, serum HBsAg, HBeAg and HBV DNA load in all fetuses in the observation group were negative, while they were positive in 5 cases, 4 cases and 4 cases in the control, with the blocking failure of 12.7%, much higher than 0.0% in the observation (P＜0.05). Conclusion The oral administration of tenofovir with HBIG and HBVac combination immunization could successfully block the mother-to-infant transmission of HBV, without severe untoward effects or pregnancy outcomes, which warrants further clinical investigation.

Key words: Hepatitis B virus carriers, Mother-to-child transmission, Human hepatitis B immunoglobulin, Hepatitis B vaccine, Pregnancy

杨晓蕾, 池振静, 孙逸冕, 王莉娟, 张晶晶, 韩娟玲. 替诺福韦联合主被动免疫阻断高血清乙型肝炎病毒载量孕妇母婴传播效果研究^*[J]. 实用肝脏病杂志, 2023, 26(2): 177-180.

Yang Xiaolei, Chi ZhenJing, Sun Yimian, et al.. Prevention of mother-to-child transmission of hepatitis B virus in pregnant women with high serum HBV loads by oral tenofovir, and human hepatitis B immunoglobulin and hepatitis B vaccine combination immunization in fetus[J]. Journal of Practical Hepatology, 2023, 26(2): 177-180.

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替诺福韦联合主被动免疫阻断高血清乙型肝炎病毒载量孕妇母婴传播效果研究^*

Prevention of mother-to-child transmission of hepatitis B virus in pregnant women with high serum HBV loads by oral tenofovir, and human hepatitis B immunoglobulin and hepatitis B vaccine combination immunization in fetus

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