核苷类似物阻断慢性乙型肝炎病毒母婴传播的临床研究

Clinical study on blocking of mother-to-child transmission of chronic hepatitis B virus via nucleoside analogues

目的探讨核苷类似物阻断慢性乙型肝炎病毒母婴传播的临床效果。方法选取该院2014年9月-2016年3月收治的慢性乙型肝炎产妇90例,根据患者对核苷类似物的使用情况将患者分为对照组、替比夫定组以及拉米夫定组3组,其中对照组产妇不服用核苷类似物,替比夫定组产妇则在第28孕周开始每天服用600mg的替比夫定,直至产后4周;拉米夫定组产妇则在第28孕周开始每天服用100mg的拉米夫定,直至产后4周。分析比较各组产妇新生儿的乙型肝炎病毒表面抗原阳性率。结果对照组产妇28例,替比夫定组产妇29例,拉米夫定组产妇33例,共分娩新生儿90例,其中对照组新生儿28例,替比夫定组新生儿29例,拉米夫定组新生儿33例。经治疗后,各组新生儿在出生时的HBsAg阳性率比较,差异无统计学意义(均P>0.05);在出生1年后替比夫定组和拉米夫定组新生儿的HBsAg阳性率均显著低于对照组,差异有统计学意义(χ2=5.634,χ2=3.827,均P<0.05)。替比夫定组和拉米夫定组新生儿在出生时和出生1年后的HBsAb阳性率比较,差异无统计学意义(均P>0.05)。结论替比夫定和拉米夫定均能够降低孕晚期慢性乙型肝炎孕妇HBV垂直传播的风险,但两者阻断效果并没有显著差异。

Objective To explore the clinical effect of nucleoside analogues in blocking of mother-to-child transmission of chronic hepatitis B virus. Methods Ninety pregnant women with chronic hepatitis B treated in Shiyan Maternal and Child Health Care Hospital from September 2014 to March 2016 were selected and divided into control group,telbivudine group,and lamivudine group according to the use of nucleoside analogues. The pregnant women in control group were not treated by nucleoside analogues; the pregnant women in telbivudine group were treated by telbivudine from the 28 th gestational week to the fourth week after delivery,600 mg per day; the pregnant women in lamivudine group were treated by lamivudine from the 28 th gestational week to the fourth week after delivery,100 mg per day. The positive rates of Hbs Ag among neonates born by the pregnant women in the three groups were analyzed and compared. Results The numbers of pregnant women in control group,telbivudine group,and lamivudine group were 28 cases,29 cases,and 33 cases,respectively. Ninety neonates were born,including 28 neonates in control group,29 neonates in telbivudine group,and 33 neonates in lamivudine group. After treatment,there was no statistically significant difference in positive rate of Hbs Ag in neonates at birth among the three groups( P>0. 05). At one year after birth,the positive rates of Hbs Ag in telbivudine group and lamivudine group were statistically significantly lower than that in control group( χ~2= 5. 634,P<0. 05; χ~2= 3. 827,P<0. 05). There was no statistically significant difference in the positive rates of Hbs Ag in neonates at birth and at one year after birth between telbivudine group and lamivudine group( P> 0. 05). Conclusion Both telbivudine and lamivudine can reduce the risk of mother-to-child transmission of chronic hepatitis B virus in pregnant women with chronic hepatitis B during the third trimester of pregnancy,and the blocking effects of the two nucleoside analogues have no significant difference.