抗病毒治疗对高病毒载量乙型肝炎孕妇HBV母婴传播的阻断作用及其安全性探讨

Discussion on blocking effect and safety of antiviral therapy on mother-to-child transmission of HBV in pregnant women with high viral load of hepatitis B

目的探讨在高病毒载量乙型肝炎孕妇中抗病毒治疗对乙型肝炎病毒(HBV)母婴传播的阻断作用及安全性。方法选取36例高病毒载量乙型肝炎孕妇作为研究对象,均采用替比夫定抗病毒治疗。对比治疗前后乙肝病毒脱氧核糖核酸(HBV-DNA)定量检测结果、肝功能指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、血清总胆红素(TBIL)和直接胆红素(DBIL)]变化,统计母婴传播率并观察不良反应。结果治疗前HBV-DNA定量检测结果为(42.61±5.71)×10^5copies/ml,治疗后HBV-DNA定量检测结果为(0.68±0.12)×10^5 copies/ml;治疗后HBV-DNA定量检测结果优于治疗前,差异有统计学意义(t=44.050, P=0.000<0.05)。治疗前ALT、AST、TBIL和DBIL水平分别为(306.85±38.96)U/L、(212.83±29.74)U/L、(63.71±8.75)μmol/L、(28.96±4.77)μmol/L,治疗后ALT、AST、TBIL和DBIL水平分别为(77.02±10.13)U/L、(61.22±9.07)U/L、(24.26±5.08)μmol/L、(6.59±1.52)μmol/L;治疗后ALT、AST、TBIL和DBIL水平均低于治疗前,差异有统计学意义(P<0.05)。36例孕妇均顺利分娩,对新生儿进行检测发现有2例感染HBV, HBV母婴传播率为5.56%(2/36);治疗期间均无肾功能损伤,无消化道不适表现,新生儿未发现畸形。结论对高病毒载量乙型肝炎孕妇采用替比夫定抗病毒治疗能够有效降低病毒载量,改善肝功能,阻断HBV母婴传播,并且安全性高,无明显不良反应。

Objective To discuss the blocking effect and safety of antiviral therapy on mother-to-child transmission of hepatitis B virus(HBV) in pregnant women with high viral load.Methods A total of 36 hepatitis B virus pregnant women with high viral load as study subjects all received tebivudine antiviral therapy. Quantitative detection results of hepatitis B virus deoxyribonucleic acid(HBV-DNA),changes of liver function indexes [alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBIL) and direct bilirubin(DBIL)were compared before and after treatment. Mother-to-child transmission rate was counted and adverse reactions were observed. Results Patients had HBV-DNA quantitative test results as(42.61 ±5.71)×10^5 copies/ml before treatment,and(0.68±0.12)×10^5 copies/ml after treatment.Patients had better HBV-DNA quantitative test results after treatment than that before treatment,and the difference was statistically significant(t=44.050,P=0.000<0.05).Patients had ALT,AST,TBIL and DBIL level respectively as(306.85±38.96)U/L,(212.83±29.74)U/L,(63.71±8.75)μmol/L and(28.96±4.77)μmol/L before treatment, and(77.02± 10.13) U/L,(61.22±9.07) U/L,(24.26±5.08)μmol/L and(6.59±1.52)μmol/L after treatment. Patients had lower ALT, AST, TBIL and DBIL level than those before treatment, and the difference was statistically significant(P<0.05). All the 36 pregnant women gave birth smoothly,and 2 cases were infected with HBV,with mother-to-child transmission rate of HBV as 5.56%(2/36). During the treatment period, there were no renal function damage, no digestive tract discomfort and no malformation in newborns. Conclusion Telbivudine antiviral therapy for pregnant women with high viral load of hepatitis B can effectively reduce viral load,improve liver function,block mother-to-child transmission of HBV,with high safety and no obvious adverse reactions.