妊娠中期应用替比夫定控制乙型肝炎病毒携带孕妇病毒载量及其阻断母婴传播效果分析

Efficacy of telbivudine on viral load loss and mother-to-child transmission in pregnant women with chronic hepatitis B viral carrier

目的探讨在妊娠中期应用替比夫定控制乙型肝炎病毒携带孕妇病毒载量,观察其阻断HBV母婴传播的效果。方法2016年2月~2018年2月我院就诊的60例妊娠中期HBV携带者被随机分为对照组30例和观察组30例。在妊娠6个月时,给予观察组替比夫定口服,直至分娩结束后1周,对照组孕妇不接受抗病毒治疗。两组新生儿出生后均常规注射重组乙肝疫苗和乙肝免疫球蛋白。采用酶联免疫吸附法检测血清白细胞介素-2(IL-2)、IL-4和IL-6水平。HBsAg)水平。采用实时荧光定量PCR法检测血清HBV DNA水平,采用电化学发光法检测血清HBsAg。结果治疗前,两组血清HBV DNA水平无统计学差异(P>0.05),分娩前,观察组血清HBV DNA水平为(3.7±0.7)lg copies/mL,显著低于对照组[(7.8±1.0)lg copies/mL,P<0.05];分娩后,观察组血清IL-2水平为(20.6±2.7)pg/mL,显著高于对照组[(15.7±1.3)pg/mL,P<0.05],血清IL-4水平为(19.7±1.5)pg/mL,显著低于对照组[(30.6±2.8)pg/mL,P<0.05],血清IL-6水平为(21.5±4.2)pg/mL,显著低于对照组[(29.7±5.1)pg/mL,P<0.05];两组新生儿胎龄、体质量、身长和Apgar评分比较无统计学差异(P>0.05);在新生儿6月龄和1岁时,观察组无HBV感染病例,而在对照组有1例(3.3%)患儿感染。结论在妊娠中期给予携带HBV孕妇替比夫定治疗可阻断HBV母婴传播,且对婴儿无不良影响。

Objective The aim of this study was to observe the efficacy of telbivudine on viral load loss and mother-to-child transmission in pregnant women with chronic hepatitis B viral carrier.Methods 60 pregnant women with HBV carrier were randomly divided into two groups in our hospital between February 2016 and February 2018,and 30 cases in the observation at six month of pregnancy were,while another 30 in the control were not given telbivudine until the end of delivery.All newborns were routinely injected with recombinant hepatitis B vaccine and hepatitis B immunoglobulin after birth.Serum HBV DNA,HBsAg,interleukin-2(IL-2),IL-4 and IL-6 levels were assayed.Results Before anti-viral treatment,serum HBV DNA loads in the two groups were not significantly different(P>0.05),while serum HBV DNA level after delivery in the observation group was(3.7±0.7)lg copies/mL,significantly lower than[(7.8±1.0)lg copies/mL,P<0.05]in the control;after delivery,serum IL-2 level in the anti-viral group was(20.6±2.7)pg/mL,significantly higher than[(15.7±1.3)pg/mL,P<0.05],serum IL-4 level was(19.7±1.5)pg/mL,significantly lower than[(30.6±2.8)pg/mL,P<0.05],and serum IL-6 level was(21.5±4.2)pg/mL,much lower than[(29.7±5.1)pg/mL,P<0.05]in the control;the gestational age,height,body mass and Apgar’s scores of newborns in the two groups were not significantly different(P>0.05);at 6 month and one year follow-up,there was one infant having HBV infection in the control,while there was no infant infected in the observation.Conclusion We recommend oral telbivudine administration at second trimester of pregnancy for blocking mother-to-child HBV transmission in women carrying HBV,which might safe and efficacious.