替比夫定联合乙肝免疫球蛋白、乙肝疫苗阻断HBV母婴垂直传播的效果及安全性

Blocking effect and safety of telbivudine combined with hepatitis B immunoglobulin and hepatitis B vaccine in HBV maternal-infant vertical transmission

目的探讨替比夫定联合乙肝免疫球蛋白、乙肝疫苗在阻断HBV母婴垂直传播中应用的效果。方法将120例妊娠合并乙型肝炎患者作为研究对象,根据随机数字表法分为试验组和对照组各60例。于孕末期,试验组孕妇口服替比夫定,对照组孕妇未采取干预措施;两组孕妇所产的新生儿均于生后24 h内注射乙肝免疫球蛋白,并定期接种乙肝疫苗。比较两组孕妇的丙氨酸转氨酶(ALT)、HBV-DNA载量和妊娠情况,比较两组孕妇所产新生儿1岁龄时的乙肝血清标志物以及生长发育情况。结果与对照组孕妇分娩前相比,试验组孕妇分娩前的ALT及HBV-DNA载量均较低,两组差异有统计学意义(P<0.01);试验组分娩前的ALT、HBV-DNA载量均低于治疗前,差异有统计学意义(P<0.01)。对照组的母婴传播阻断率为98.3%,对照组的母婴传播阻断率为86.1%,两组差异有统计学意义(P<0.01)。两组产妇产后出血及新生儿生长发育状况相比差异均无统计学意义(P>0.05)。结论替比夫定联合乙肝免疫球蛋白和乙肝疫苗可提高母婴垂直传播的阻断率,但对妊娠结局以及新生儿的生长发育状况无不利影响。

Objective To explore the blocking effect of telbivudine combined with hepatitis B immunoglobulin and hepatitis B vaccine in HBV maternal-infant vertical transmission.Methods A total of 120 pregnant women with hepatitis B were selected and divided into experimental group and control group according to random number table,60 pregnant women in each group.At the end of pregnancy,the pregnant women in experimental group were treated with oral administration of telbivudine,while the pregnant women in control group did not receive any intervention measures;the neonates born by the pregnant women in the two groups were treated by immunoglobulin injection within24 hours after birth,hepatitis B vaccine was vaccinated regularly.Alanine aminotransferase（ALT） level,HBV-DNA load and pregnancy outcomes in the two groups were compared.The levels of hepatitis serum markers,growth and development of 1-year-old neonates born by the pregnant women in the two groups were compared.Results Compared with the pregnant women before delivery in control group,ALT level and HBV-DNA load in experimental group were lower,there were statistically significant differences between the two groups（P〈0.01）.In experimental group,ALT level and HBV-DNA load before delivery were statistically significantly lower than those before treatment（P〈0.01）.The blocking rates of HBV maternal-infant vertical transmission in experimental group and control group were 98.3% and86.1%,respectively,there was statistically significant difference between the two groups（P〈0.01）.There was no statistically significant difference in the incidence rate of postpartum hemorrhage and neonatal growth and development between the two groups（P〉0.05）.Conclusion Telbivudine combined with hepatitis B immunoglobulin and hepatitis B vaccine can improve the blocking rate of HBV maternal-infant vertical transmission,but it has no adverse impact on pregnancy outcome and neonatal growth and development.