替诺福韦酯阻断乙肝母婴传播的疗效评价

Efficacy and safety of tenofovir disoproxil fumarate in blocking mother-to-child transmission of hepatitis B

目的 探讨慢性乙型肝炎孕妇妊娠中晚期口服替诺福韦酯(tenofvir disoproxil fumarate,TDF)阻断乙型肝炎病毒母婴传播的疗效与安全性。方法 选取2017年9月至2019年6月于本院肝胆病科门诊接受TDF抗病毒治疗的慢性乙肝中晚期孕妇30例,连续用药至分娩当天停药,新生儿出生后均采取标准的免疫预防措施。对比孕妇TDF治疗前、分娩前及停药后ALT、AST及HBV DNA载量水平,并观测乙肝病毒在母婴之间的阻断情况及停药后母亲的安全性等。结果 经TDF治疗后,孕妇分娩前ALT及AST水平差异均无统计学意义(P>0.05),HBV DNA载量水平较基线水平明显下降,差异具有统计学意义(P<0.05)。入组孕妇所产新生儿随访期12月内血清HBsAg阳性率为0%,母婴阻断率达100%,且新生儿生长发育状况良好,未见畸形及发育异常。停药后1~3月内,产妇HBV DNA载量水平逐渐升高到产前水平,至停药后12月,共计7例产妇出现肝功能异常(23.33%),其中2例轻度升高,未予治疗自行缓解,5例(16.67%)重新给予抗乙肝病毒治疗后恢复正常。结论孕中晚期口服TDF抗病毒治疗能够有效且安全地阻断HBV的母婴传播,分娩后立即停药有一定肝功能异常风险,但予以规范治疗后病情可控,安全性较好。

ObjectiveTo investigate the efficacy and safety of oral tenofovir disoproxil fumarate(TDF)in blocking mother-to-child transmission of hepatitis B virus(HBV)in pregnant women with chronic hepatitis B in the second and third trimesters of pregnancy.MethodsThirty pregnant women with chronic hepatitis B who received TDF for antiviral therapy in the Hepatobiliary Clinic of our hospital from September 2017 to June 2019 were selected. They received continuous administration until the day of delivery.Standard immunoprophylaxis measures were taken for all newborns after birth. The levels of alanine aminotransferase(ALT), aspartate aminotransferase(AST), and HBV DNA load of pregnant women before TDF treatment, before delivery, and after drug withdrawal were compared. The blocking of HBV from mother to child and the safety of mother after drug withdrawal were observed.ResultsAfter TDF treatment, the ALT and AST levels of pregnant women before delivery showed no significant changes from baseline(P > 0.05), and the HBV DNA load level was significantly reduced compared with the baseline level(P < 0.05). The positive rate of serum hepatitis B surface antigen of newborns from the enrolled pregnant women was 0% within 12 months of follow-up, reaching a maternal-infant blocking rate of 100%. Moreover, the newborns were in good growth and development, without malformation or developmental abnormality. Within 1 ~ 3 months after drug withdrawal, the HBV DNA load level of puerperae gradually increased to the prenatal level. By 12 months after drug withdrawal, a total of 7 puerperae(23.33%)showed abnormal liver function, among whom 2 puerperae showed mild elevation and spontaneous remission without treatment, and 5 puerperae(16.67%)returned to normal after re-administration of anti-HBV treatment.ConclusionOral TDF for antiviral therapy in the second and third trimesters of pregnancy can effectively and safely block the mother-to-child transmission of HBV. Immediate drug withdrawal after delivery can bring a certain risk of liver function abnormality,while the disease can be controlled after standard treatment.