慢性乙肝病毒感染妇女妊娠中后期替比夫定抗病毒治疗的临床观察

Clinical study of telbivudine anti-virus treatment during middle to late pregnancy of the pregnant women with hepatitis B

目的 :观察替比夫定在慢性乙型肝炎病毒(hepatitis B virus,HBV)感染妇女妊娠中后期的应用效果,为育龄乙型肝炎妇女治疗方案的选择提供依据。方法:回顾性分析2011年1月—2016年12月在南通大学附属南通第三医院和南通大学附属医院分娩的乙型肝炎表面抗原(hepatitis B surface antigen,HBsAg)/乙型肝炎病毒e抗原(hepatitis B virus e antigen,HBeAg)双阳性,HBV-DNA≥1×107 copies/m L伴不同程度的转氨酶升高孕妇390例,分为替比夫定组252例和对照组138例,比较两组肝功能的转归和HBV-DNA载量的变化,观察两组母婴不良妊娠结局,比较两组患者的母婴传播情况。结果:与对照组比较,替比夫定组谷丙转氨酶和谷草转氨酶显著下降(P<0.001),临产前、产后7个月、产后1年HBV-DNA载量均较对照组下降明显(P<0.001);且不增加胎膜早破、产后出血、新生儿窒息、低出生体质量儿的发生率(P>0.05),产后7个月、产后1年婴儿HBsAg阳性率低于对照组(P<0.001),替比夫定使母婴传播率下降。结论:孕妇妊娠中后期替比夫定能有效阻断母婴传播,促进肝功能恢复,降低HBV-DNA载量,不增加母婴并发症的发生。

Objective： To investigate the application o f telbivudine in the middle to late stage of the pregnant women with hepatitis B（HBV）, so as to provide the basis for their cure program. Methods： A retrospective study of 390 pregnant women with both hepatitis B surface antigen（HBs Ag） and hepatitis B virus e antigen（HBe Ag） positive from January 2011 to December2016 was performed, they came from the Nantong Third Hospital Affiliated to Nantong University and Affiliated Hospital of Nantong University, and were divided into telbivudine group, 252 csases with both HBs Ag/HBe Ag positive, HBV-DNA≥1×107 copies/m L and different degrees of increase in aminotransferase,and control group, 138 cases with both HBs Ag/HBe Ag positive, HBV-DNA ≥1 ×107 copies/m L and different degrees of increase in aminotransferase. The transference of the liver functions and the changes in the carrier quantity of HBV-DNA in the two groups were compared, so as to observe the outcome of poor pregnancy and further compare the transmission between the mother and the infant. Results： Compared with the controls, the telbivudine group could promote the recovery of the liver functions and a significant decrease in transaminase（P〈0.001） and the carrier quantity of HBV-DNA was reduced. The carrier quantity of HBV-DNA was reduced significantly before partureincy, in the seventh month and a year after bearing as compared with in the control group（P〈0.001）. While the incidence rate, premature rupture of membranes, postpartum hemorrhage neonatal asphyxia and low-birth weight infants were not increased（P〈0.05）. The rate with positive HBs Ag of the telbivudine group in the seventh month and a year after bearing was lower than that in the controls（P〈0.001）, so that the transmission rate between the mother and the infant was reduced. Conclusions： Telbivudine significantly reduces vertical transmission of HBV from pregnant women to their infants, promotes the recovery of the liver functions and reduces the carrier quantity of HBV-DNA, and no complications of the mother and the infant are increased.