妊娠不同时期应用替诺福韦阻断高病毒载量乙型肝炎孕妇母婴传播的效果分析

Analysis of the effect of tenofovir in blocking mother to child transmission of hepatitis B in pregnant women with high viral load at different stages of pregnancy

目的探讨妊娠不同时期应用替诺福韦阻断高病毒载量乙型肝炎孕妇母婴传播的临床效果。方法选取高病毒载量乙型肝炎孕妇120例为研究对象,随机分为三组,各40例。A组孕妇在孕早期(第6周)开始服用替诺福韦;B组在孕中期(第14周)开始服用替诺福韦;C组在孕晚期(第28周)开始服用替诺福韦。观察比较三组孕妇治疗前和分娩时HBV-DNA、HBsAg及HBeAg水平、新生儿出生后感染状况以及三组治疗期间不良反应发生情况。结果分娩时A、B、C三组的HBV-DNA、HBsAg和HBeAg水平均较治疗前降低(P<0.01),A、B组降低幅度大于C组(P<0.01);A、B组母婴传播感染发生率均低于C组(P<0.01);三组不良反应发生率无显著差异(P>0.05)。结论对HBV病毒载量高的孕妇,在妊娠早、中期给予替诺福韦抗病毒治疗,相比妊娠晚期用药,可显著降低孕妇的病毒载量,提高母婴传播阻断率,且用药安全性良好。

Objective To investigate the clinical effect of tenofovir in blocking mother to child transmission of hepatitis B in pregnant women with high viral load at different stages of pregnancy.Methods The hundred and twenty pregnant women with high viral load were randomly divided into three groups,forty in each group.Group A began to take tenofovir in the early pregnancy(sixth week);group B began to take tenofovir in the middle pregnancy(fourteenth week);group C began to take tenofovir in the late pregnancy(twenty-eighth week).The changes of HBV-DNA,HBsAg and HBeAg levels before treatment and during delivery were observed and compared among the three groups.Results During delivery,the levels of HBV-DNA,HBsAg and HBeAg in group A,B and C were significantly lower than those before treatment(P<0.01),and the reduction of those indexs in group A and B were significantly lower than those in group C(P<0.01),the infecting rate of mother to child transmission in group A and B was also significantly lower than that in group C(P<0.01),there was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion For pregnant women with high HBV viral load,it is recommended to give tenofovir anti-virus treatment before or in the early and middle stages of pregnancy.Compared with the drug used in the late stage of pregnancy,it can significantly reduce the viral load of pregnant women,improve the blocking rate of mother to child transmission,and the safety of medication is good,which is worthy of clinical application.