TDF与TAF阻断乙型肝炎病毒携带孕妇HBV母婴传播效果和妊娠结局分析*

doi:10.3969/j.issn.1672-5069.2026.04.005

摘要/Abstract

摘要： 目的分析比较富马酸替诺福韦二吡呋酯(TDF)与富马酸丙酚替诺福韦(TAF)治疗乙型肝炎病毒(HBV)携带孕妇阻断HBV母婴传播的效果。方法 2022年1月~2025年1月我院诊治的HBV携带孕妇99例,被分为两组,在妊娠28周分别给予TAF治疗45例和TDF治疗44例,至分娩停药。给予新生儿常规接种乙肝疫苗和乙型肝炎免疫球蛋白,随访12个月。常规临床检测,包括尿β2微球蛋白(β2-MG)水平,计算估算的肾小球滤过率(eGFR)。采用ELISA法检测血清HBsAg水平,采用实时荧光定量PCR法检测血清HBV DNA载量,应用多因素二元Logistic回归分析影响母婴传播阻断效果的因素。结果在分娩结束时,两组孕妇血清ALT、HBV DNA载量和eGFR水平比较,无显著性差异(P>0.05),但TDF组尿β2-MG水平为(2.0±0.4)mg/L,显著高于TAF组[(0.4±0.1)mg/L,P<0.05];两组孕妇和新生儿不良结局发生率(13.3%对15.9%)比较无显著性差异(P>0.05);两组母婴传播阻断成功率(95.6%对93.2%)比,也无显著性差异(P>0.05);5例阻断失败组孕妇年龄、基线血清HBV DNA载量和人工喂养占比均显著大于或高于阻断成功组(P<0.05),而新生儿出生体质量显著低于阻断成功组(P<0.05);多因素Logistic回归分析结果显示,孕妇年龄大、HBV DNA载量高和新生儿出生体质量低均是导致母婴传播阻断失败的独立危险因素(P<0.05)。结论 TDF和TAF均可应用于阻断HBV携带孕妇HBV母婴传播。针对血清病毒高载量孕妇是否需要提前应用抗病毒药物,值得开展研究。

关键词: 乙型肝炎病毒携带者, 孕妇, 富马酸替诺福韦二吡呋酯, 富马酸丙酚替诺福韦, 母婴传播, 阻断

Abstract: Objective The aim of this study was to investigate blocking hepatitis B virus (HBV) maternal-infant transmission by tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide fumarate (TAF) in hepatitis B viral carriers. Methods 99 pregnant women carrying HBV were enrolled in our hospital between January 2022 and January 2025, and were assigned to receive TAF (n=45) or receive TDF (n=44) at 28 weeks of gestation until delivery completed. 99 neonates were vaccinated with hepatitis B vaccine and hepatitis B immunoglobulin immediately after birth, and were followed-up for 12 months after delivery. Serum biochemical parameters and urinary β2-microglobulin (β2-MG) levels were detected routinely, and estimated glomerular filtration rate (eGFR) was calculated. Serum HBsAg level was detected by ELISA, and serum HBV DNA loads were detected by real-time fluorescence quantitative PCR. Multivariate binary Logistic regression analysis was applied to analyze the factors affecting blocking efficacy. Results By delivery, there were no significant differences as respect to serum ALT levels, HBV DNA loads and eGFR between the two groups (P>0.05), while urine β2-MG level in TDF group was (2.0±0.4)mg/L, much higher than [(0.4±0.1)mg/L, P<0.05] in TAF group; incidences of adverse outcomes related to pregnancy both in women or infants (13.3% vs. 15.9%) in the two groups were not significantly different (P>0.05); successful blocking in the two groups (95.6% vs. 93.2%) was also not significantly different (P>0.05); ages of pregnant women, baseline serum HBV DNA loads and percentage of formula feeding in 5 children with failed blocking were much older, greater or higher (P<0.05), while body mass of newborns at delivery was much lower than in 94 children with successful blocking(P<0.05); multivariate Logistic regression analysis showed that older pregnant women, higher baseline serum HBV DNA loads and lower body mass at birth were all the impacting factors for failed blocking(P<0.05). Conclusion Both TDF and TAF have a similar antiviral efficacy for blocking mother-to-child HBV transmission in pregnant women carrying HBV, and whether antiviral intervention should be started in advance needs clinical investigation.

Key words: Hepatitis B virus carriers, Pregnant women, Tenofovir disoproxil fumarate, Tenofovir alafenamide fumarate, Maternal-infant transmission, Blocking

樊秀瑾, 邵雯, 孙冷. TDF与TAF阻断乙型肝炎病毒携带孕妇HBV母婴传播效果和妊娠结局分析^*[J]. 实用肝脏病杂志, 2026, 29(4): 497-500.

Fan Xiujin, Shao Wen, Sun Leng. Blocking HBV maternal-infant transmission by tenofovir disoproxil fumarate or tenofovir alafenamide fumarate in hepatitis B viral carriers[J]. Journal of Practical Hepatology, 2026, 29(4): 497-500.

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TDF与TAF阻断乙型肝炎病毒携带孕妇HBV母婴传播效果和妊娠结局分析^*

Blocking HBV maternal-infant transmission by tenofovir disoproxil fumarate or tenofovir alafenamide fumarate in hepatitis B viral carriers

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