孕期使用核苷(酸)类药物预防乙型肝炎病毒母婴传播的效果和不良事件

Efficacy and adverse events of nucleos(t)ide analogues in the prevention of perinatal transmission of hepatitis B during pregnancy

乙型肝炎（乙肝）病毒（hepatitis B virus,HBV）母婴传播,即乙肝表面抗原（hepatitis B surface antigen,HBsAg）阳性孕妇将HBV传给子女,是我国慢性HBV感染的主要原因。HBsAg阳性母亲的子女,经联合应用乙肝免疫球蛋白和乙肝疫苗的正规免疫预防后,HBeAg阴性孕妇,其子女感染率仅0～＜1%;HBeAg阳性者，子女感染率为10％左右。母婴传播的主要危险因素是HBVDNA水平或HBeAg阳性，故有学者对HBVDNA高水平孕妇在孕晚期用核苷（酸）类药物[nucleos（t）-ide analogues，NAs]抗病毒治疗，以减少HBV母婴传播。

Mother-to-infant transmission of hepatitis B remains the main cause of chronic hepatitis B virus （HBV） infection in China. With the passive-active immunoprophylaxis, only 〈 1% infants born to HBV-infec- ted mothers with negative HBeAg become chronically infeeted; however, approximately 10% of the infants born to HBeAg-positive mothers are infected. The major risk factor of transmission is high maternal HBV DNA level or HBeAg positivity. Recently, it is shown that the use of nucleos（t）ide analogues （NAs） against HBV infection in pregnant women with positive HBeAg may reduce or eliminate the mother-to-infant transmis- sion. However, the safety of these drugs is the major concern because using NAs during pregnancy appears to be associated with more adverse events for both pregnant women/mothers and their fetus/infants. Thus, it should be cautious to treat pregnant women with NAs for the prevention of mother-to-infant transmission of hepatitis B.