孕晚期抗病毒治疗乙型肝炎病毒感染对阻断母婴传播的影响

Effect of treatment of hepatitis B virus infection during late pregnancy on blocking mother-to-child transmission

目的探究孕晚期抗病毒治疗乙型肝炎病毒(HBV)感染对阻断母婴传播的影响。方法将海南省妇幼保健院就诊的孕晚期HBV感染240例孕妇随机分为研究组120例及对照组120例,研究组每日口服一次替比夫定600 mg,每月一次肌注乙型肝炎免疫球蛋白(HBIG)200 IU至分娩后停药,对照组每月一次肌注HBIG 200 IU,所有孕妇治疗前均接受HBV两对半及HBV DNA检测,所有新生儿出生后马上取静脉血行乙肝病毒两对半检查及乙肝病毒DNA定量。对新生儿的畸形、窒息、早产、剖宫产及产后出血情况进行记录。结果研究组与对照组治疗前后,HBV DNA研究组平均下降量高于对照组(P<0.05)。研究组HBV DNA阳性58例,宫内感染4例,占6.90%;阴性62例,宫内感染0例。对照组HBV DNA阳性59例,宫内感染18例,占30.51%;阴性61例,宫内感染0例。HBV阳性患者中,研究组宫内感染率低于对照组(P<0.05)。两组孕妇及新生儿的畸形率、窒息率、早产率、剖宫产率、产后出血率、出生体质量、身长、阿氏评分(Apgar评分)及胎龄进行对比分析,差异无统计学意义。结论孕晚期孕妇进行抗病毒治疗可有效降低新生儿HBV感染率,且抗病毒治疗药物替比夫定的安全性高,不会对新生儿的生长发育造成影响。

OBJECTIVE To explore the effect of treatment of hepatitis B virus(HBV)infection on blocking mother-to-child transmission.METHODS A total of 240 pregnant women with HBV infection during late pregnancy who were treated in the Women and Children Hospital of Hainan Province were randomly divided into the study group with 120 cases and the control group with 120 cases.The study group was treated with oral administration of 600 mg telbivudine once a day and intramuscular injection of hepatitis B immunoglobulin(HBIG)once a month till the delivery;the control group was treated with intramuscular injection of HBIG once a month.All of the pregnant women received the tests of fiver markers of HBV and HBV DNA,the venous blood specimens were drawn from all of the neonates for the test of fiver markers of HBV and HBV DNA quantification as soon as they were born.The incidence of neonatal malformations,asphyxia,premature delivery,cesarean section and postpartum hemorrhage was recorded.RESULTS The average decline of HBV-DNA of the study group was significantly greater than that of the control group before and after the treatment(P<0.05).Of 58 pregnant women who were positive for HBV-DNA in the observation group,4 had intrauterine infection,accounting for 6.90%;62 pregnant women were negative,and there was no case of intrauterine infection.Of 59 pregnant women who were positive for HBV-DNA in the control group,18 had intrauterine infection,accounting for 30.51%;18 pregnant women were negative,and there was no case of intrauterine infection.Among the HBV-positive patients,the incidence of intrauterine infection of the study group was significantly lower than that of the control group(P<0.05).There were no significant differences in the incidence of neonatal malformations,asphyxia,premature delivery,cesarean section and postpartum hemorrhage and birth weight,height,Apgar score as well as gestational age between the two groups of pregnant women.CONCLUSION The antiviral therapy for the late pregnancy women may effectively reduce the incidence rate of HBV infection.As a drug for the antiviral therapy,telbivudine is safe and may not affect the growth and development of the neonates.