拉米夫定和替比夫定阻断乙型病毒性肝炎病毒母婴传播的疗效分析

Efficacy of lamivudine or telvudine administered to prevent hepatitis B virus vertical transmission

目的评价拉米夫定(LAM)和替比夫定(LDT)阻断乙型病毒性肝炎病毒(HBV)母婴传播的疗效及安全性。方法乙型病毒性肝炎病毒表面抗原(HBs Ag)和乙型病毒性肝炎病毒e抗原(HBe Ag)双阳性孕妇36例,按患者意愿分为LAM组16例及LDT组20例,同期未接受抗病毒治疗的HBs Ag和HBe Ag双阳性孕妇22例作为对照组。治疗组自孕28周至分娩后3月口服LAM或LDT,观察各组在孕28周、分娩时和分娩后3个月血清HBV DNA水平及婴儿出生、8月龄血清HBs Ag及HBV DNA的阳性率。结果 LAM及LDT组孕妇分娩及分娩后3个月HBV DNA显著低于对照组(P<0.05);但LAM和LDT组HBV DNA下降差异无统计学意义(分娩时P>0.05;产后3月:P>0.05)。出生及8个月龄LAM、LDT组婴儿HBs Ag和HBV DNA阳性率均显著低于对照组(均P<0.05)。结论 HBs Ag和HBe Ag双阳性孕妇在妊娠晚期服用LAM或LDT均可有效阻断乙肝病毒母婴传播,2种药物疗效差异无统计学意义。

Objective To evaluate the safety and curative effect of lami-vudine （ LAM） or telvudine （ LDT） administered to interrupt maternal -neonatal transmission of hepatitis B virus.Methods Thirty-six preg-nant women with both HBsAg and HBeAg positive were recruited in this study.The mothers were given a choice to receive LAM or LDT treatment in late pregnancy.The control group had 22 pregnant women never re-ceiving anti-viral therapy.The treatment group was given lamivudine or telvudine from 28 weeks of pregnancy to 3 months after delivery.The HBV DNA of subjects at 28 weeks of pregnancy , giving birth and 3 months after delivery , as well as the positive rates of HBV DNA and HBsAg in newborn infants and when they were 8 month -old were observed.Results The HBV DNA in LAM and LDT group were signifi-cantly lower than that in control group at the time of delivery and 3 months after deli-very（ P0.05;3 months after delivery： P〉0.05 ）.The positive rates of HBV DNA and HBsAg in newborn infants and when they were 8 month-old in LAM and LDT group were lower than those in control group （ P 〈0.05 ） . Conclusion LAM or LDT administered in late pregnancy can significantly＆nbsp;prevent vertical transmission of hepatitis B virus , but no statistical difference of the two drugs has been found.