替比夫定防止134例胎儿宫内乙型肝炎病毒感染的疗效研究

Telbivudine Treatment of 134 Cases of Pregnant Women with Chronic Hepatitis B

目的：替比夫定阻断妊娠中晚期胎儿宫内感染乙型肝炎（简称乙肝）病毒（HBV）的疗效及安全性研究。方法：选择2009年1月—2011年1月在武汉市江夏区第一人民医院就诊的确诊为合并慢性乙肝的妊娠中晚期患者134例,基于患者意愿,分为治疗组（86例）和对照组（48例）。妊娠22-32周,治疗组口服替比夫定抗病毒治疗,对照组口服复方甘草酸苷片治疗。足月分娩时均抽取脐带血检测乙肝全项,24 h内给新生儿各注射乙肝疫苗10μg及乙肝免疫球蛋白200 IU,同时序贯给予乙肝疫苗免疫。结果：治疗前2组患者年龄、孕周、HBV拷贝数、血丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）差异无统计学意义（均P〉0.05）。经过替比夫定治疗后,治疗组患者分娩时HBV拷贝数下降,肝功能好转,产后出血发生率降低（均P〈0.05）。治疗组新生儿出生时脐带血HBV感染率低于对照组（P〈0.05）,但2组新生儿肝功能均正常（P〉0.05）。不同分娩方式新生儿1年后HBV感染率差异无统计学意义（χ2CMH=0.067 8,P=0.794 5）。结论：口服替比夫定阻断乙肝宫内感染治疗安全有效,值得进一步推广。

Objective ：Study was performed on the safety and efficacy of telbivudine in blocking HBV intrauterine infection of fetus in late pregnancy. Methods：In 134 cases with chronic hepatitis B is that of women in late trimester of pregnancy of 22-32 weeks when they visited our hospital, based on the wishes of patients. 134 cases were divided into treatment group （n=86, treated with oral telbivudine antiviral therapy） and control group （n=48, given with compound glycyrrhizin tablets treatment）. After the full-term babies delivered the umbilical cord blood were taken for testing of HBsAg, within 24 h for neonatal hepatitis B vaccine injection 10 p.g and hepatitis B immune globulin 200 IU, at the same time sequential administration of hepatitis B vaccine immunization. Results：Patients＇ age, HBV DNA quantitative, gestational weeks and liver function indexes （ALT, AST） had no significant difference before the treatments in the two groups （P〉0.05）. After treatment, HBV DNA quantitative, liver function indexes were lower than those in the control group when the pregnancies termination （P〈0.05）. The positive rate of HBsAg in treatment group was lower than that in the control group （P〈0.05） at the birth. However, the mode of delivery in patients of the 2 groups had no effect on neonatal hepatitis B infection rate （P〉0.05）. Different mode of delivery of neonatal HBV infection had no significant difference after one year （X2CMS=0.067 8, P=0.794 5 ）. Conclusions ： The treatment of oral telbivudine blocking HBV intrauterine infection is safe and effective, and is worthy of further promotion.