替诺福韦酯治疗阻断妊娠晚期HBV携带孕妇病毒母婴传播的疗效和安全性评价

摘要/Abstract

摘要： 目的探究替诺福韦酯对妊娠晚期HBV携带孕妇病毒治疗阻断母婴传播的疗效。方法回顾性分析2018年1月—2020年12月期间于嘉定区中心医院诊治的HBV携带孕妇112例。将孕妇分为对照组和观察组,观察组在孕26～28周开始服用替诺福韦酯,分娩后停止用药。对照组不使用抗病毒药物治疗。两组婴儿出生24 h均给予100 IU乙型肝炎免疫球蛋白,同时0、1、6个月接受乙型肝炎疫苗。比较两组孕妇和新生儿的ALT、HBV DNA、HBsAg和HBeAg、新生儿生长发育情况以及孕妇的不良反应。结果对照组治疗前和分娩后12周的HBV DNA分别为(7.3±0.6)log₁₀ IU/mL和(7.1±0.8)log₁₀ IU/mL,观察组治疗前和分娩后12周的HBV DNA分别为(7.4±0.3)log₁₀ IU/mL和(6.9±0.9)log₁₀ IU/mL(P>0.05),分娩前观察组和对照组的HBV DNA分别为(3.2±0.7)log₁₀ IU/mL 和(7.2±0.4) log₁₀ IU/mL,差异有统计学意义(P<0.05)。观察组的新生儿在分娩时、6月龄和12月龄的HBsAg阳性率、HBeAg阳性率和HBV DNA阳性率低于对照组新生儿,观察组新生儿的HBV感染率低于对照组P<0.05)。两组孕妇未发生不良反应且胎儿均生长发育良好。结论采用替诺福韦酯治疗阻断妊娠晚期HBV携带孕妇具有较好的抗病毒作用,在兼具安全性的同时,母婴传播率也降低明显。

关键词: 乙型肝炎病毒, 妊娠晚期, 替诺福韦酯, 阻断, 母婴传播

Abstract: Objective To investigate the efficacy and safety of tenofovir dipivoxil in preventing mother-to-child transmission of hepatitis B virus (HBV) in carriers during late pregnancy. Methods Our study included 112 pregnant women with HBV who were diagnosed and treated at Jiading District Central Hospital between January 2018 and December 2020. The participants were divided into two groups: a control group and an observation group. The observation group received tenofovir disoproxil fumarate from 26-28 weeks of gestation until delivery, while the control group did not receive antiviral treatment. All infants from both group were administered 100 IU of hepatitis B immunoglobulin within 24 hours after birth and received the hepatitis B vaccine at 0, 1 and 6 months. We compared ALT levels, HBV DNA, HBsAg and HBeAg, neonatal growth and development, and adverse reactions in pregnant women between the two groups. Results The HBV DNA levels in the control group before treatment and 12 weeks postpartum were (7.3±0.6) log₁₀ IU/mL and (7.1±0.8) log₁₀ IU/mL, respectively (P<0.05). In the observation group, the HBV DNA levels were (7.4±0.3) log₁₀ IU/mL before treatment and (6.9±0.9) log₁₀ IU/mL 12 weeks postpartum (P<0.05). The HBV DNA level in the observation group before delivery was (3.2±0.7) log₁₀ IU/mL, significantly lower than that of the control group (7.2±0.4) log₁₀ IU/mL, with a statistically significant difference(P<0.05). The HBsAg positive rate, HBeAg positive rate, and HBV DNA positive rate in newborns from the observation group were lower than those in the control group at birth, and at 6 and 12 months. Furthermore, the HBV infection rate in newborns from the observation group was significantly lower compared to the control group (P<0.05). No cass of abortion, liver or kidney dysfunction, or postpartum hemorrhage occurred in either group of pregnant women. Fetal growth and development were satisfactory in both groups. Conclusion The use of tenofovir disoproxil fumarate during the third trimester of pregnancy in women with hepatitis B virus shows strong antiviral efficacy, is safe, and significantly reduces the rate of mother-to-child transmission.

Key words: Hepatitis B virus, Late pregnancy, Tenofovir dipivoxil, Blocking, Maternal to child transmission

樊慧杰, 姜国伟. 替诺福韦酯治疗阻断妊娠晚期HBV携带孕妇病毒母婴传播的疗效和安全性评价[J]. 肝脏, 2024, 29(10): 1247-1250.

FAN Hui-jie, JIANG Guo-wei. Efficacy and safety of tenofovir dipivoxil in preventing mother-to-child transmission of hepatitis B virus during late pregnancy[J]. Chinese Hepatolgy, 2024, 29(10): 1247-1250.

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