合并HBV感染孕妇口服替诺福韦对母婴传播阻断效果及安全性研究

Safety of oral tenofovir and efficacy on the prevention of mother-to-child transmission in pregnant women with HBV infection

目的 探讨合并HBV感染孕妇口服替诺福韦对母婴传播阻断效果及安全性研究。方法 选取2014年1月—2018年10月来我院就诊的80例合并HBV感染的孕妇作为研究对象,采用随机数字表法将其分为观察组(n=40)和对照组(n=40)。观察组给予口服替诺福韦至分娩,对照组给予口服替比夫定至分娩。2组新生儿出生后均给予标准免疫预防(乙型肝炎人免疫球蛋白100 IU+乙型肝炎疫苗),对比2组孕妇血清HBV DNA、ALT及CRE水平,HBV母婴传播阻断效果,产后出血量、产后出血率、不良反应发生率。结果 分娩前,观察组HBV DNA及ALT水平均明显低于对照组[(2.87±0.37)×10^6IU/ml vs.(4.27±0.51)×10^6 IU/ml、(27.03±3.41)U/L vs.(45.21±5.18)U/L],同时CRE水平明显高于对照组[(266.38±31.34)mg/L vs.(183.93±22.45)mg/L](P均<0.05);观察组母婴阻断成功率明显高于对照组(100%vs. 87.5%)(P <0.05);观察组产后出血量明显低于对照组[(421.42±49.28)ml vs.(493.17±51.04)ml],同时观察组产后出血率及不良反应发生率均明显低于对照组(P均<0.05)。结论 口服替诺福韦对合并HBV感染的孕妇可有效降低血清HBV DNA、ALT水平,提高CRE水平,母婴阻断成功率高,安全性好,在临床上值得推广及应用。

Objective To explore the safety of oral tenofovir and efficacy of preventing mother-to-child transmission in pregnant women with hepatitis B infection.Methods Eighty pregnant women with hepatitis B virus infection admitted to our hospital from January 2014 to October 2018 were included in this study,and they were divided into observation group(n=40)and control group(n=40)according to random number table method.In the observation group,the patients were given oral tenofovir until delivery,while the patients in the control group were given oral telbivudine until delivery.The newborns in 2 groups received standard immunoprophylaxis(hepatitis B human immune globulin 200 IU+hepatitis B vaccine).Serum levels of HBV DNA,alanine aminotransferase(ALT)and creatinine(CRE),effect of preventing HBV mother-to-child transmission,postpartum blood loss,incidence of postpartum hemorrhage rate and adverse reactions were compared between 2 groups.Results Before delivery,HBV DNA and ALT levels in the observation group were significantly lower than those in the control group[(2.87±0.37)×10^6 IU/ml vs.(4.27±0.51)×10^6 IU/ml,(27.03±3.41)U/L vs.(45.21±5.18)U/L],and CRE levels were significantly higher than those in the control group[(266.38±31.34)mg/L vs.(183.93±22.45)mg/L](P<0.05).The success rate of preventing mother-to-child transmission in the observation group was significantly higher than that in the control group(100%vs.87.5%)(P<0.05).The amount of postpartum blood loss in the observation group was significantly lower than that in the control group[(421.42±49.28)ml vs.(493.17±51.04)ml],and the incidence of postpartum hemorrhage and adverse reactions in the observation group was significantly lower than that in the control group(P<0.05).Conclusions Oral administration of tenofovir can effectively reduce serum HBV DNA and ALT levels,elevate CRE level in pregnant women combined with HBV infection,improve success rate of preventing mother-to-child transmission.It is a safe approach and worthy of promotion and application in clinical practice.