妊娠期应用替比夫定降低HBV母婴传播风险的研究进展

Research advances in the application of telbivudine during pregnancy to prevent HBV mother-to-child transmission

HBV DNA高载量孕妇分娩的新生儿即使接受乙型肝炎疫苗联合免疫阻断预防治疗后仍有10%的HBV感染率。对于HBV DNA高载量孕妇群体临床开始尝试于孕中晚期应用核苷和核苷酸类药物(拉米夫定、替比夫定和替诺福韦)以提高乙型肝炎母婴传播阻断效果。对HBV DNA高载量孕妇妊娠晚期使用替比夫定的抗病毒治疗策略、抗病毒治疗后母体HBV DNA水平变化情况、是否能继续提高母婴传播阻断成功率、母婴双方的安全性、最佳服药和停药时间及母乳喂养等方面作一综述。

Almost 10% of neonates whose mothers have a high HBV DNA load may have HBV infection, even after the preventive treatment with hepatitis B vaccine and immune interruption. In pregnant women with a high HBV DNA load, nucleos （t）ide analogues （lamivudine, telhivudine, and tenofovir） have been used in the second and third trimesters to improve the interruption of mother- to -child transmission of hepatitis B. This article reviews the strategies for antiviral therapy with telbivudine for pregnant women with a high HBV DNA load in their third trimester, changes in maternal HBV DNA level after antiviral therapy, whether the success rate of interruption of mother - to - child transmission can be further increased, safety in mothers and infants, the most appropriate time for drug administration and withdrawal, and hreasffeediug issues.