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*

doi:10.3969/j.issn.1672-5069.2014.03.008

摘要/Abstract

摘要： 目的探讨在妊娠晚期应用替比夫定阻断乙型肝炎病毒母婴传播的临床疗效和安全性。方法应用计算机检索中国生物医学文献数据库、万方医学数据库、中文科技期刊数据库、中国知网、PubMed、ISI web of knowledge、EMbase、Cochrane Library、BIOSIS Previews等数据库,截止日期为2013年9月。参照纳入和排除标准进行文献筛选,采用RevMan5.1软件进行Meta分析。结果纳入文献11篇,共1241例孕妇,其中应用替比夫定602例,对照组639例;Meta分析结果显示,随访6~12月龄婴儿,替比夫定组HBsAg和HBV DNA阳性率均低于对照组,差异有统计学意义[RR=0.15,95%CI（0.08,0.28）,P<0.00001;RR=0.12,95%CI（0.05,0.32）,P<0.0001];替比夫定组孕妇分娩前HBV DNA水平低于对照组,差异有统计学意义[MD=-3.86,95%CI（-4.55,-3.16）,P<0.00001];替比夫定组肌酸激酶升高率高于对照组,差异有统计学意义[MD=-3.86,95%CI（-4.55,-3.16）,P<0.00001],应用替比夫定孕妇所产新生儿无畸形等并发症发生。结论替比夫定能阻断HBV宫内感染,其应用安全、有效。

关键词: 乙型肝炎, 替比夫定, 宫内感染, 孕妇, Meta分析

Abstract: Objective To systematically review the efficacy and safety of telbivudine in preventing mother-to-infant transmission of hepatitis B virus in the third trimester of pregnancy. Methods Chinese Biomedical Literature Database,WanFang Database Online,Chinese Scientific Journals Database,CNKI,PubMed,ISI web of knowledge,EMBASE,Cochrane Library and BIOSIS Previews were searched for related articles till September 2013. Two reviewers independently screened these articles according to inclusion and exclusion criterion. Meta-analysis was performed by using software Rvman 5.1. Results Eleven papers were included in this study,with a total of 1241 pregnant women,including 602 cases received telbivudine and 639 cases of control;Meta-analysis showed that, after a 6 to 12 month of follow-up,the seropositive rates for HBsAg and HBV DNA in babies of telbivudine-treated mothers were significantly lower than in babies of non-treated mothers[RR=0.15,95%CI（0.08,0.28）,P<0.00001;RR=0.12,95%CI（0.05,0.32）,P<0.0001,respectively];Maternal HBV DNA levels prior to delivery was significantly lower in telbivudine-treated women than in non-treated women[MD=-3.86,95%CI（-4.55,-3.16）,P<0.00001];The rate of elevation in serum creatine kinase （CK） was significantly higher in telbivudine-treated mothers than in non-treated mothers[MD=-3.86,95%CI（-4.55,-3.16）,P<0.00001];The neonates in telbivudine group were born without deformity and other complications. Conclusion Telbivudine is effective and safe in blocking HBV intrauterine infection.

Key words: Hepatitis B, Telbivudine, Intrauterine transmission, Pregnancy, Meta analysis

陈君, 孙晓风, 邓泽润, 张跃新, 周莹丽, 刘浩. 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): 249-255.

Chen Jun, Sun Xiangfeng, Deng Zerun. Efficacy and safety of telbivudine in preventing intrauterine transmission of hepatitis B virus in the third trimester of pregnancy:a systematic review[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2014, 17(3): 249-255.

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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^*

Efficacy and safety of telbivudine in preventing intrauterine transmission of hepatitis B virus in the third trimester of pregnancy:a systematic review

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