替比夫定治疗妊娠期e抗原阴性慢性乙型肝炎的临床效果观察

Clinical effect of telbivudine in pregnant patients with e antigen-negative chronic hepatitis B

目的：探讨替比夫定治疗妊娠期 e 抗原阴性慢性乙型肝炎的临床效果。方法选择90例 e 抗原阴性慢性乙型肝炎孕妇，并通过数字表法将患者随机分为两组，分为观察组50例，对照组40例。观察组孕妇使用替比夫定治疗，对照组孕妇使用复方甘草酸苷治疗。对比两组孕妇治疗前后 HBV DNA 水平、转阴率、血清 ALT 水平、妊娠结局。结果观察组与对照组治疗后 HBV-DNA 水平相比治疗前均显著降低，对照组患者治疗前为（6．37±1．18）mL，分娩后6周为（5．49±1．21）mL；观察组患者治疗前为（6．31±1．21）mL，分娩后6周为（0．23±0．04）mL，差异有统计学意义（t ＝8．154，P ＜0．01）；观察组分娩前、分娩后6周 HBV-DNA 分别为（0．21±0．05）lg Copeis／mL、（0．23±0．04）lg Copeis／mL，均明显低于对照组，经过统计学处理，差异有统计学意义（t ＝19．257，P ＝0．000；t ＝8．154，P ＝0．000）；观察组治疗后4周、治疗后8周、分娩后6周 HBV-DNA转阴率分别为52．00％、60．00％、88．00％，均显著高于对照组，经过统计学处理，差异均有统计学意义（χ2＝142．41、184．58、177．61，P ＜0．01）；观察组与对照组治疗后 ALT 水平相比治疗前均有显著降低，经过统计学处理，差异有统计学意义（t ＝29．665，P ＜0．01）；观察组分娩前、分娩后6周 ALT 分别为（12．58±2．58）U ／L、（18．44±3.43）U ／L，均明显低于对照组，经过统计学处理，差异有统计学意义（t ＝54．251，P ＝0.000；t ＝29.665，P ＝0.000）；观察组不良妊娠发生率为14．00％，与对照组比较差异无统计学意义（χ2＝0.524，P ＝0.493）。结论替比夫定治疗妊娠期 e 抗原阴性慢性乙型肝炎临床效果较好，可控制肝炎活动，降低病毒水平，值得临床推广应用。

Objective To investigate clinical effect of telbivudine used in e antigen -negative chronic hepatitis B pregnant patients,to provide a reference for clinical treatment.Methods 90 pregnant patients with chronic hepatitis B e antigen -negative were selected,they were divided into two groups,50 patients in the control group and 40 patients in the observation group.The observation group used telbivudine treatment,the control group used the compound glycyrrhizin treatment.Before and after treatment,HBV DNA levels,negative rate,serum ALT levels,pregnancy outcome were compared between the two groups.Results After treatment,HBV -DNA in the two groups was significantly decreased compared with before treatment,before treatment,the HBV -DNA of the control group was （6.37 ± 1.18）mL,6 weeks after delivery was （5.49 ±1.21）mL;before treatment,the HBV -DNA of the observation group was （6.31 ±1.21）mL,6 weeks after delivery was （0.23 ±0.04）mL.The difference was statistically significant （t =8.154,P〈0.01 ）.In the observation group,before birth,six weeks after childbirth HBV -DNA were （0.21 ± 0.05）lg copy/mL,（0.23 ±0.04）lg copy/mL,which were significantly lower than those of the control group,the differences were significant （t =19.257,P =0.000;t =8.154,P =0.000）.4 weeks,8 weeks after treatment,six weeks after childbirth,the HBV -DNA negative conversion rates of the control group were 52.00%,60.00%, 88.00%,which were significantly lower than the observation group （χ2 =177.61,142.41,184.58,P〈0.01 ）. Compared with before treatment,ALT levels after treatment were significantly decreased in the two groups （t =29.665,P〈0.01）.Before birth,six weeks after birth,ALT levels in the observation group were （12.58 ±2.58）U /L, （18.44 ±3.43）U /L,which were significantly lower than the control group （t =54.251,P =0.000;t =29.665,P =0.000）.The incidence rate of adverse pregnancy of the observation group was 14.00%,compared with the control group the difference was not statistically significant （χ2 =0.524,P =0.493 ）.Conclusion Telbivudine in the treatment of gestational e antigen -negative chronic hepatitis B pregnant patients has good clinical effect,it can help to control hepatitis activity and reduce virus levels,which is worthy of clinical application.