妊娠期抗乙肝病毒药物使用指南争议性问题的总结和比较

Summarization and comparison of controversial issues in guidelines for the use of anti-hepatitis B virus drugs during pregnancy

围产期母婴垂直传播(mother-to-child transmission,MTCT)是引起慢性乙型肝炎病毒(hepatitis B virus,HBV)传播的主要途径之一,尽管我国慢性HBV感染孕妇所生新生儿采用了标准的乙肝免疫球蛋白(hepatitis B immunoglobulin,HBIG)和乙肝疫苗进行被动、主动免疫预防,但是仍然有5%~10%的新生儿感染HBV,其中孕妇高病毒载量是母婴阻断失败的主要原因。而口服抗病毒药物治疗被证实可进一步降低HBV母婴传播,但是目前各大指南对于高病毒载量孕妇何时使用抗病毒药物、病毒载量阈值、首选抗病毒药物类型、母乳喂养等问题仍然存在争议,在这篇综述中,讨论了这些存在争议的孕期口服抗病毒药物治疗问题,旨在为预防HBV感染MTCT的管理提供理论参考。

Mother-to-child transmission(MTCT)in the perinatal period is one of the main ways to cause the transmission of chronic hepatitis B virus(HBV),and although standard hepatitis B immunoglobulin and hepatitis B vaccine have been used for passive and active immunization in the neonates born to pregnant women with chronic HBV infection in China,5%~10%of the neonates are still infected with HBV,with the high viral load of pregnant women as the main reason for the failure of mother-to-child blocking.Evidence has proved that oral antiviral drugs can further reduce the mother-to-child transmission of HBV;however,major guidelines still have controversies over issues such as the timing of the use of antiviral drugs in pregnant women with high viral load,viral load threshold,preferred type of antiviral drugs,and breastfeeding.This review discusses the controversial issues of oral administration of antiviral drugs during pregnancy,in order to provide a theoretical reference for managing MTCT of HBV infection.