替诺福韦酯在乙型肝炎母婴阻断中的合理应用

Rational Application of Tenofovir Disoproxil in Maternal and Child Block of Hepatitis B

目的探讨替诺福韦酯阻断母婴垂直传播乙肝病毒(HBV)的疗效及安全性。方法随机选择2015年12月-2018年12月期间该院妇产科就诊且分娩的乙肝产妇121例,随机分为两组,妊娠中晚期使用替诺福韦酯和替比夫定分别治疗,并评估婴儿HBV感染情况和治疗安全性。结果监测7个月龄婴儿HBV-DNA及乙肝两对半等指标。替比夫定治疗组HBsAg阳性率(6.77%)及HBV-DNA(5.00%)阳性率均高于使用替诺福韦的抗病毒组(0.00%、0.00%),但组间差异无统计学意义(P>0.05),疗效差异不显著。替诺福韦酯组不良反应发生率0.00%显著低于替比夫定组10.00%,差异有统计学意义(χ~2=4.470,P<0.05)。结论妊娠晚期使用替诺福韦酯或替比夫定均可有效阻断乙肝病毒母婴传播,疗效无明显差别,但替诺福韦酯优于替比夫定,更加可靠安全。

Objective To study the efficacy and rational application of tenofovir in blocking the vertical maternal-neonatal transmission of hepatitis B virus(HBV). Methods 121 cases of hepatitis B pregnant women were convenient selected for gynecology and obstetrics from December 2015 to December 2018, and were randomly divided into two groups. Tenofovir and tibivudine were used in the middle and late stages of pregnancy respectively, and the status and safety of HBV infection in infants were assessed. Results The indicators of HBV-DNA and hepatitis B were measured in July infants. The positive rates of HBsAg(6.77 %) and HBV-DNA(5.00 %) in the tibivudine treatment group were higher than those of the antiviral group using tinofovir(0.00%, 0.00%), but the difference between groups was not statistically significant(P>0.05). There was no significant difference in efficacy. The incidence of adverse reactions in the tenofovir disoproxil group was 0.00%, which was significantly lower than the 10.00% in the tenbivudine group. The difference was statistically significant(χ~2=4.470, P<0.05). Conclusion The use of tenofovir or tibivudine in late pregnancy can effectively block the mother-to-child transmission of hepatitis B virus. There is no significant difference in curative effect, but tenofovir is superior to tibivudine and is more reliable and safe.