替比夫定治疗妊娠中晚期乙型肝炎病毒感染免疫耐受期高病毒血症孕妇的效果及停药后丙氨酸氨基转移酶升高比例观察

Effect of telbivudine in treatment of hyperplasma viremia pregnant women during immune tolerant phase of hepatitis B virus infection and during the second and the third trimesters of pregnancy and observation on the proportion of pregnant women with increa

目的研究替比夫定(Ld T)治疗妊娠中晚期乙型肝炎病毒(HBV)感染免疫耐受期高病毒血症孕妇的效果及停药后丙氨酸氨基转移酶(ALT)升高比例。方法选取该院2013年1月-2015年12月住院部确诊的HBV感染孕妇130例,观察组(102例)给予Ld T治疗,对照组(28例)不给予抗病毒治疗。统计治疗及分娩前后观察组血清HBV指标,记录分析观察组和对照组分娩后ALT升高比例,并对比两组婴儿HBV感染情况。结果观察组治疗1个月后HBV DNA水平明显低于治疗前,差异有统计学意义(t=27.601,P<0.001);观察组分娩前HBV DNA水平显著低于治疗前,差异有统计学意义(t=33.739,P<0.001);观察组分娩后1个月HBV DNA水平略低于治疗前,差异无统计学意义(t=0.266,P>0.05);HbsAg和HbeAg在治疗前、治疗1个月、分娩前及分娩后1个月4个时期均无明显变化,差异无统计学意义(P>0.05);观察组和对照组分娩前ALT均无升高,分娩后1个月内观察组出现1.96%ALT升高,略低于对照组的3.57%,差异无统计学意义(χ~2=0.687,P>0.05);分娩后6个月内观察组出现3.92%ALT升高,略高于对照组的3.57%,差异无统计学意义(χ~2=0.271,P>0.05);观察组无一例HbsAg阳性或HBV DNA阳性,对照组2例确诊感染HBV,差异有统计学意义(χ~2=7.253,P<0.01)。结论 LdT能明显降低妊娠中晚期HBV感染免疫耐受期高病毒血症孕妇的HBV DNA水平,并有效阻断母婴的HBV垂直感染,且安全性较高。

Objective To research the effect of telbivudine（ Ld T） in treatment of hyperplasma viremia pregnant women during immune tolerant phase of hepatitis B virus（ HBV） infection and during the second and the third trimesters of pregnancy and observation on the proportion of pregnant women with increased alanine aminotransferase（ ALT） level after drug withdrawal. Methods A total of 130 HBV-infected pregnant women were selected from the hospital from January 2013 to December 2015,then they were divided into two groups,the women in observation group（ 102 women） were treated with Ld T,and the women in control group（ 28 women） were not given antiviral treatment.The serum HBV indexes in observation group before and after delivery,the proportion of pregnant women with increased ALT level after delivery in experimental group and control group were recorded and analyzed,HBV infection situations in the two groups were compared.Results The level of HBV DNA in observation group after 1 month of treatment was statistically significantly lower than that before treatment（ t= 27. 601,P〈0. 001）; before delivery,the level of HBV DNA in observation group was statistically significantly lower than that before treatment（ t = 33. 739,P〈0. 001）; the level of HBV DNA in treatment group at 1 month after delivery was slightly lower than that before treatment,but there was no statistically significant difference（ t = 0. 266,P〈0. 05）; there was no statistically significant difference in HbsAg and HbeAg among the four periods： before treatment,after 1 month of treatment,before delivery,and at 1 month after delivery（ P〈0. 05）;ALT level before delivery didn＇t increase in the two groups,at 1 month after delivery,the proportion of pregnant women with increased ALT level was 1. 96%,which was slightly lower than that in control group（ 3. 57%）,there was no statistically significant difference（ χ~2= 0. 687,P〈0. 05）; within 6 months after delivery,the proportion in observation group was 3. 92%,which was slightly higher than that in control group（ 3. 57%）,there was no statistically significant difference（ χ^2= 0. 271,P〈0. 05）; in observation group,no case was found with positive HbsAg or positive HBV DNA,2 cases in control group were diagnosed as HBV infection,there was statistically significant difference between the two groups（ χ^2= 7. 253,P〈0. 01）. Conclusion LdT can significantly reduce the level of HBV DNA and effectively block HBV vertical transmission in hyperplasma viremia pregnant women during immune tolerant phase of hepatitis B virus infection and during the second and the third trimesters of pregnancy,and the security is high.