阻断乙型肝炎病毒父婴传播的临床研究

Clinical research on the blocking effect of nucleoside analogue on HBV father-to-infant transmission

目的 研究乙型肝炎病毒（HBV）父婴传播的阻断效果.方法 设观察组、对照组,检测父亲、母亲的肝功能、HBV-M、HBV DNA以进一步分组.检测新生儿出生时静脉血HBVM、HBVDNA以分组观察.观察组共325对,对照组314对.研究夫妇所生的新生儿观察组A301例（24对夫妇妊娠未成功）、对照组A309例入选,两组新生儿均无死亡.对观察组HBV DNA阳性父亲进行核苷类似物抗病毒治疗,所有新生儿出生后接受HBIG、HBVac联合注射或接受单独HBVac注射（新生儿出生时抗-HBs阳性者）.结果 观察组A301例新生儿出生时抗HBs阳性288例,无一例HBsAg阳性,无一例HBV DNA阳性.对照组A309例新生儿出生时抗HBs阳性229例,47例HBV DNA阳性,29例HBsAg阳性,两组对比差异有统计学意义.HBV DNA阳性、HBsAg阳性新生儿经联合注射后HBV DNA阴转率59.57％,HBsAg阴转率48.27％.结论 孕前HBV DNA阳性的父亲进行核苷类似物抗病毒治疗使其阴转或较低载量对阻断父婴垂直传播有意义,且是安全的.出生时HBV DNA阳性、HBsAg阳性的新生儿,经联合注射后仍使部分新生儿得到有效的阻断。

Objective To explore the blocking effects of nucleoside analogue treatment of HBV positive father on father-to-infant transmission of HBV infection.Methods A total of 301 couples were enrolled into the observation group and 309 couples were enrolled into the control group,to study the effects of treatment of HBV-positive fathers with nucleotide analog on father-to-infant transmission of HBV infection,the fathers＇ and mother ＇s liver function and HBV-markers （HBVM）,HBV DNA were determined.The neonatal venous blood HBVM,HBV DNAwere also determined.The HBV DNA positive fathers in the observation group were treated with nucleoside analogue.All the infants received HBIG,HBVac joint injections or received only HBVac when anti-HBs was positive.Results In the observation groupA,anti-HBs was positive in 288 of 301 cases at birth,no one case was HBVDNA positive and HBsAg positive.In the control group,anti-HBs was positive in 229 of 309 cases at birth,47 cases were positive for HBVDNA,29 cases were HBsAg positive,the two groups had significant difference.In the newborns who were HBVDNA positive and HBsAg positive,after combined injections with HBIG and HBVac,HBV DNA became negative in 59.57%,HBsAg became negative in 48.27%.Conclusion Treatment of pregnancy HBVDNA-positive fathers with nucleoside analogue antiviral agent could block the father-infant vertical transmission of HBV infection and the therapy was safe.In newborn infants who were HBVDNA and HBsAg positive at birth,the joint injection effectively blocked the infection in part of the neonates.