HBV感染免疫耐受期孕妇不同孕周应用核苷(酸)类似物阻断母婴传播的疗效

Efficacy of nucleos(t)ide analogue antiviral therapy on interrupting mother-to-child transmission of hepatitis B virus

目的探讨核苷(酸)类似物用于慢性HBV感染免疫耐受期孕妇抗病毒治疗的起始孕周。方法 2013年1月1日~2016年4月1日于解放军第302医院妇产中心产检并住院分娩且完成产后1年随访的孕期应用核苷(酸)类抗病毒治疗的慢性HBV感染孕妇共213例。根据开始抗病毒治疗时间分为孕24周组和孕28周组,分析两组患者血清HBV DNA下降、母婴阻断成功率、母婴并发症以及停药后肝功能异常发生率。结果孕24周组和孕28周组孕妇抗病毒治疗4周时HBV DNA载量分别为(4.53±0.59)log_(10)IU/ml和(4.42±0.43)log_(10)IU/ml(t=1.58、P=0.07),较基线水平下降约3.4 log_(10)IU/ml;两组患者抗病毒治疗8周时HBV DNA载量分别为(3.82±0.43)log_(10)IU/ml和(3.68±0.39)log_(10)IU/ml(t=0.06、P=2.44);抗病毒治疗4周至8周两组患者HBV DNA平均下降约0.7 log_(10)IU/ml;两组患者分娩前HBV DNA载量分别为(2.82±0.48)log_(10)IU/ml和(3.30±0.53)log_(10)IU/ml(t=3.83、P=0.07)。两组新生儿7月龄和12月龄时HBsAg均为阴性,母婴阻断成功率均为100%。两组患者母婴并发症、新生儿生长发育指标、出生缺陷率以及停药后ALT升高发生率差异均无统计学意义。结论高HBV载量的免疫耐受期孕妇无需提前抗病毒治疗,可根据需要适当推迟用药,但需保证至少4周抗病毒治疗疗程。

Objective To investigate the initial gestational week of nucleos（t）ide analogue antiviral therapy on interrupting mother-to-child transmission（MTCT） of hepatitis B virus（HBV）. Methods From January 1 st, 2013 to April 1 st, 2016, a total of 213 women with chronic HBV infection who received nucleos（t）ide antiviral treatment during maternal examinations at the Maternity Center of the 302 Military Hospital were hospitalized and completed one year follow-up after delivery. According to the initial antiviral time, these patients were divided into 24-week group（74 cases） and 28-week group（149 cases）. The levels of serum HBV DNA decline, success rate of maternal and child block, complication in maternal and children as well as liver dysfunctions after antiviral therapy withdrawal between two groups were compared, respectively. Results The HBV DNA levels of pregnant women in the 24-week group and 28-week groups after 4 weeks of antiviral treatment were（4.53 ± 0.59） log10 IU/ml and（4.42 ± 0.43） log10 IU/ml, with significant difference（t = 1.58, P = 0.07）, which was approximately 3.4 log10 IU/ml lower than the baseline level. The HBV DNA levels of pregnant women in the 24-week group and 28-week groups after 8 weeks of antiviral therapy were（3.82 ± 0.43） log10 IU/ml and（3.68 ± 0.39） log10 IU/ml（t = 0.06, P = 2.44）, with significant difference. The mean decrease level of HBV DNA in pregnant women during 4-8 weeks antiviral treatment was approximately 0.7 log10 IU/ml. The HBV DNA levels of prelaber in the two groups were（2.82 ± 0.48） log10 IU/ml and（3.30 ± 0.53） log10 IU/ml, with significant difference（t = 3.83, P = 0.07）. HBV DNA groups were negative for HBsAg at 7 months and 12 months of age, and the success rate of maternal and infant blocks was 100%. There was no significant difference in maternal and child complications, neonatal growth and development indicators, birth defect rate and the incidence of ALT elevation after discontinuation. Conclusions Patients with high viral load of chronic HBV infection were not required to treat in advance in pregnancy, and could be delayed according to clinical needs, but should be guaranted for at least 4 weeks.