关键词: 替诺福韦, 替比夫定, 妊娠, 乙型肝炎病毒, 母婴传播

Abstract: Objective To compare the blocking effects of tenofovir and telbivudine combined with dual immunization regimen on maternal-fetal transmission of hepatitis B virus (HBV) during pregnancy.Methods A total of 82 HBV-infected pregnant women admitted to our hospital from January 2016 to July 2018 were randomly divided into tenofovir group and telbivudine group, 41 cases each. The 2 groups started taking drugs at 28 weeks of gestation, the tenofovir group receiving tenofovir 300 mg once daily, the telbivudine group receiving telbivudine 600 mg once daily. Breastfeeders stopped medication after delivery, and those who did not breastfeed were given medication until 4 weeks after delivery. Both 2 groups of infants were injected with hepatitis B immunoglobulins and hepatitis B vaccines. The serum alanine aminotransferase (ALT) and HBV DNA levels of the pregnant women 1 day before taking medication and within 3 days before delivery, the hepatitis B surface antigen (HBsAg) positive rate, hepatitis B e antigen (HBeAg) positive rate, incidence of HBV DNA ≥100 IU/mL of the infants at birth and 1 year after birth, pregnancy outcomes and adverse reactions were compared between the 2 groups.Results The serum ALT and HBV DNA levels within 3 days before delivery were significantly lower than 1 day before taking medication in both groups (P<0.05). The serum ALT and HBV DNA levels in the tenofovir group within 3 days before delivery were significantly lower than those in the telbivudine group (32.65 ± 6.91 vs 43.25 ± 7.11 U/L, 2.89 ± 0.56 vs 3.67 ± 0.67 IU/mL, P<0.05). There were no significant differences in HBsAg positive rate, HBeAg positive rate or incidence of HBV DNA≥100 IU/ml between the 2 groups at birth or 1 year after birth (P>0.05). No abortion, postpartum hemorrhage, liver or kidney dysfunction were observed during the treatment in the 2 groups. There were no significant differences in the incidence rates of premature delivery, cesarean section, fetal malformation, maternal anemia, pregnancy-induced hypertension and maternal high serum bile acid between the 2 groups (P>0.05).Conclusion Both tenofovir and telbivudine combined with dual immunization regimen can effectively inhibit HBV replication, reduce serum viral load and block HBV mother-to-child transmission. The former has higher clinical value, which has stronger inhibitory effect on HBV and is beneficial to improve liver function.

Key words: Tenofovir, Telbivudine, Pregnancy, Hepatitis B virus, Mother-to-child transmission