广东地区妊娠与抗乙型肝炎病毒治疗的回顾性调查研究

Retrospective analysis of the efficacy and safety of anti-hepatitis B virus drugs taken during pregnancy in women from the Guangdong Province

目的 调查妊娠期抗HBV治疗对阻断母婴传播的有效性及对母婴的安全性. 方法 设计回顾性调查表格,收集广东省内18家医院33名专家填写的妊娠期服用抗HBV药物且资料完整的病案,统计分析新生儿及产妇的相关数据. 结果 共收集到122例妊娠或授精期抗病毒治疗及随访资料较完整的病案;74例女性妊娠期抗病毒药物涉及最多为拉米夫定,其次为替比夫定;48例男性授精前抗病毒药物涉及最多的为拉米夫定,其次为阿德福韦酯;122例新生儿均未感染HBV;74例产妇均未发生产科并发症;1例女性孕期全程服用替比夫定出现新生儿低体质量（2.1kg）,2例男性服用阿德福韦酯意外授精后分别出现新生儿兔唇及腹股沟疝各1例,其余均未发现其他出生缺陷. 结论 广东地区回顾性资料显示,妊娠期抗病毒治疗能有效协助阻断母婴传播,且安全性好.

Objective To investigate the efficacy of anti-hepatitis B virus （HBV） drugs for preventing vertical transmission of HBV and the safety of these drugs when given as treatment during pregnancy （to women） or insemination （to men）.Methods Cases of women and men who had taken anti-HBV drug therapy during pregnancy or insemination,respectively,were retrospectively selected for study from among 18 hospitals and 33 specialists in the Guangdong Province.Demographic,HBV infection and treatment data was collected for puerperal men or women and their newborns from the medical records.Results A total of 122 cases with detailed follow-up data were included in the study and including 74 women who were administered lamivudine （LAM） 〉 telbivudine （LdT） 〉 adefovir （ADV）〉 entecavir （ETV） （hierarchy ranking by number of cases） and 48 men who were administered LAM 〉 ADV 〉 LdT 〉ETV.None of the 122 newborns related to these cases showed HBV infection at 7 months of follow-up.None of the 74puerperal women showed complications related to reproduction.There was one ease of a newborn being underweight at birth （2.1 kg）,for which the mother had taken LdT during pregnancy.There was also one case of a newborn with a harelip and one case of a newborn with an inguinal hernia,for which both of the fathers had taken ADV during the time of insemination.Conclusion This retrospective investigation carried out in Guangdong Province indicated that not only are anti-HBV drugs efficacious for blocking vertical transmission of HBV but also are safe for both mothers and infants when taken by fathers or mothers during the reproduction phases of insemination and pregnancy.