妊娠期妇女全程核苷（酸）类似物抗乙肝病毒疗效研究

The efficacy of antiviral treatment with nucleus （t）ide analogues during the entire pregnancy

目的探讨妊娠期全程核苷（酸）类似物治疗慢性乙型肝炎患者的抗病毒疗效。方法收集北京地坛医院2009—2013年全程接受核苷（酸）类似物治疗妊娠妇女的临床资料，包括血清HBVDNA载量、血清学和生化学指标，通过观察患者妊娠期病毒学应答、HBeAg血清学转换和生化应答来评价抗病毒的疗效。结果共收集患者125例，妊娠期病毒突破率为11．2％（14／125）。其中，妊娠前达到完全病毒应答孕妇100例，妊娠期间病毒的完全应答率为96％（96／100）及突破率为4．O％（4／100）。妊娠前HBVDNA阳性孕妇25例，妊娠期病毒突破率为40％（10／25），高于妊娠前HBVDNA阴性者，差异有统计学意义（矿=22．568，P=0．000）；11例（44％）继续使用原药物在妊娠期达到完全病毒学应答。妊娠前HBeAg阳性者89例，至分娩前HBeAg血清学转换率为4．5％（4／89）。病毒学突破的孕妇妊娠期生化突破率为4／14，未发生病毒学突破的孕妇妊娠中期至分娩前ALT复常率达100％。结论全程核苷（酸）类似物治疗的孕妇妊娠期能获得较好病毒学抑制和生化应答，但HBeAg血清学转换率较低。

Objective To investigate the efficacy of antiviral treatment with nucleus （t） ide analogues during the entire pregnancy. Method The clinical data were collected from pregnant women with nucleus （t）ide analogues during the entire pregnancy in Beijing Ditan Hospital from 2009 to 2013, including HBV DNA, serum HBV markers and biochemical indicators. The efficacy of antiviral treatment was evaluated according to virological response, HBeAg seroconversion and biochemical response during the entire pregnancy. Results Totally 125 pregnant women were enrolled in this study. There were 14 cases （11.2%） who occured virological breakthrough during pregnancy. Before preganacy, of 125 pregnant women, 100 were HBV DNA-negative and 25 were HBV DNA-positive. In HBV DNA-negative women, 96 cases continued to maintain complete virological response and other 4 cases occured virological breakthrough during pregnancy. In HBV DNA-positive women before pregnancy, 10 （40%） developed virological breakthrough during pregnancy, which was signifcantly higher than in the HBV DNA-negative women （X2 = 22. 568,P = 0.000）; 11 （44%） women who continued to use original drug had complete virological response during pregnancy. Before delivery, the rate of HBeAg seroconversion in 89 pregnant women with HBeAg positive before pregnancy was 4. 5% （4/89）. 4 cases （4/14） had biochemical breakthrough in 14 cases who had breakthrough during pregnancy; The rates of ALT normalization were 100% from the second trimester of pregnancy to delivery in others mothers. Conclusions Antiviral treatment with nucleus（t） ide analogues during the entire pregnancy was associated with high rates of HBV DNA undetectable and ALTnormalization in women with chronic hepatitis B, while the rate of HBeAg seroconversion was low.