替比夫定治疗妊娠期ALT低水平升高的HBV感染者的效果观察

Clinical effect of telbivudine in treatment of pregnant women with hepatitis B virus infection and a low-level increase in alanine aminotransferase

目的评价妊娠期特殊免疫状态下HBV感染产妇采用替比夫定抗病毒治疗的意义。方法回顾性分析2014年1月-2015年10月于首都医科大学附属北京佑安医院建档并分娩的HBs Ag阳性,且HBV DNA>10~6IU/ml的慢性乙型肝炎患者67例,分为ALT升高<2倍正常值上限抗病毒治疗组29例(A组);ALT升高≥2倍正常值上限抗病毒治疗组20例(B组);ALT低水平升高未行抗病毒治疗组18例(C组),其中A、B两组患者在妊娠12周以后给予替比夫定抗病毒治疗,观察3组孕妇分娩前HBV标志物HBsAg水平、HBeAg水平、肝脏生化指标、药物不良反应及新生儿出生缺陷等变化。计量资料多组间比较采用方差分析;计数资料多组间比较采用χ~2检验,不满足χ~2检验条件时采用Fisher精确检验。结果 3组患者肝功能复常率及分娩前HBsAg变化情况比较,差异均无统计学意义(P值均>0.05);3组产妇至分娩前HBV DNA下降≥3个对数的比例分别为44.8%、85.0%、16.7%,HBeAg下降≥50%的比例分别为41.4%、70.0%、11.1%,差异均有统计学意义(χ~2值分别为19.85、14.74,P值均<0.001)。结论妊娠期针对ALT低水平升高的患者进行抗病毒治疗,把握抗病毒时机,可有效降低母婴传播的风险。

Objective To investigate the clinical effect of antiviral therapy with telbivudine antiviral therapy in parturients with hepatitis B virus（ HBV） infection and a special immune status in pregnancy. Methods A retrospective analysis was performed for the clinical data of67 HBsAg-positive chronic hepatitis B（ CHB） patients with HBV DNA 106IU/ml who were examined and gave birth in Beijing You An Hospital,Capital Medical University,from January 2014 to October 2015. According to the level of alanine aminotransferase（ ALT）,the patients were divided into ALT 2 × upper limit of normal（ ULN） group（ 29 patients,group A）,ALT ≥2 × ULN group with antiviral therapy（ 20 patients,group B）,and low-level ALT increase group without antiviral therapy（ 18 patients,group C）. The patients in groups A and B were given antiviral therapy with telbivudine after 12 weeks of pregnancy. The three groups were observed in terms of the levels of HBV markers HBsAg and HBeAg,liver biochemical parameters,adverse drug reactions,and neonatal birth defects. An analysis of variance was used for comparison of continuous data between multiple groups,the chi-square test was used for comparison of categorical data between multiple groups,and the Fisher＇s exact test was used when the data did not meet the conditions for the chi-square test. Results There were no significant differences between the three groups in normalization rate of liver function and the change in HBsAg level at the time of delivery（ both P 0. 05）. The proportions of patients who achieved a ≥3 log reduction in HBV DNA level at the time of delivery were 44. 8%,85. 0%,and 16. 7%,respectively,in the three groups,and the proportions of patients who achieved a ≥50% reduction in HBeAg were 41. 4%,70. 0%,and 11. 1%,respectively; there were significant differences between the three groups for the two indices（ χ~2=19. 85 and 14. 74,both P 0. 001）. Conclusion The right timing of antiviral therapy for pregnant women with a low-level increase in ALT can effectively reduce the risk of mother-to-child transmission.