慢性乙型肝炎病毒母婴阻断的研究现状与争议

Prevention of mother-to-child transmission of hepatitis B virus: Research progress and controversy

乙型肝炎病毒(hepatitis B virus,HBV)感染是一个全球性的健康问题,母婴传播是HBV慢性感染的最主要原因.即使经正规的主、被动联合免疫,极大地减少了HBV垂直传播,但乙型肝炎e抗原(hepatitis B e antigen,HBeAg)阳性孕妇的新生儿仍有8%-10%会发生慢性感染.研究显示,母体血清高HBV DNA水平和HBeAg阳性可能与HBV垂直传播有关,而阻断HBV母婴传播的问题也一直是临床医师必须面对和亟待解决的实际问题,但针对乙型肝炎孕妇的抗病毒治疗指征、药物选择、服药开始与停止的时间、产后哺乳等相关问题,目前仍然存在很大的争议.本文将针对HBV母婴阻断的国内外研究现状及存在的争议作一综述以供参考.

Hepatitis B virus（HBV） infection is a global health problem. Mother-to-child transmission（MTCT, also known as vertical transmission） is the main cause of chronic HBV infection. Although combined active and passive immunization has greatly reduced the vertical transmission of HBV, about 8%-10% of newborns still acquire HBV infection, especially those from hepatitis B e antigen（HBeAg） positive mothers. Previous studies have shown that high levels of HBV DNA and positive HBeAg in serum of pregnant woman may be related to the vertical transmission of HBV. Thus, the prevention of MTCT of HBV has always been a practical question that clinicians must face and urgently needs to solve. However, there is still much controversy over the following aspects： indications of antiviral therapy, drug choice, timing of initiating and ending of antiviral agents, postpartum breast-feeding and so on. This review focuses on the consensus and controversy regarding the prevention of the vertical transmission of HBV.