替比夫定干预的乙型肝炎病毒携带孕妇分娩后抗病毒治疗的临床探讨

Efficacy of combination antiviral therapy following childbirth in pregnant HBV carriers receiving telbivudine for prevention of mother-to-child transmission

目的观察替比夫定（LdT）干预的HBV携带孕妇分娩后用聚乙二醇干扰素仅联合阿德福韦抗病毒治疗（CPIA方案）的临床疗效。方法对妊娠晚期用LdT抗病毒干预的高病毒载量的HBV携带孕妇，分娩后根据生物化学、血清学及病毒学的变化，选择ALT≥2倍正常值上限同时伴HBV DNA下降≥31gIU／ml和（或）HBeAg滴度下降≥50％者，转换为CPIA方案继续治疗，疗程96周，观察抗病毒疗效及安全性。结果共入组150例患者。分娩后45例患者转换为CPIA方案抗病毒治疗，其中91．1％（41／45）获得病毒学应答，55．60／0（25／45）获得HBeAg清除或血清学转换，26．7％（12／45）获得HBsAg清除或转换。分娩后（CPIA治疗基线）HBeAg和HBV DNA水平与HBeAg清除呈负相关。98例停用LdT，随访观察未见肝脏生物化学指标明显异常。结论对于LdT干预的HBV携带孕妇，分娩后ALT明显升高并伴有HBeAg及HBV DNA水平的显著下降，可能是适合抗病毒治疗的较好时机，采用以聚乙二醇干扰素为基础的联合治疗方案，可获得较好的疗效。

Objective To observe the clinical efficacy of combination therapy with peg-IFNα and adefovir （CPIA） in women who were hepatitis B virus （HBV） carriers and had just given birth and received telbivudine （LdT） during pregnancy for prevention of mother-to-child transmission. Methods One-hundred-and-fifty third trimester-pregnant women who were HBV carriers with highly-viremic were treated with LdT until time of birth. After delivery, those women with alanine aminotransferase （ALT） level exceeding two times the upper limit of normal and HBV DNA level that had decreased more than 31 gIU/mL or hepatitis B e antigen （HBeAg） titer that had decreased more than 50% were switched to CPIA for 96 weeks. Results Following delivery, 45 of the women were switched to the CPIA treatment, of which 91.1% （41/45） achieved virological response, 55.6% （25/45） achieved HBeAg clearance or seroeonversion, and 26.7% （12/45） achieved hepatitis B surface antigen （HBsAg） clearance or The immediate post-delivery （and pre-CPlA） levels of HBeAg and HBV DNA were negatively associated with HBeAg clearance. Ninety-eight of the total study participants stopped the LdT treatment and there were no eases of significant deterioration of liver function. Conclusion Pregnant women who are HBV carriers and receive LdT for protection against mother-to-child transmission, and who show significant ALT elevation and decreased I-IBeAg titer and/or reduced HBV DNA after delivery, may be good candidates for the CPIA therapy following delivery.