高乙型肝炎病毒载量妊娠中晚期孕妇应用替比夫定阻断HBV母婴传播的效果及其降低孕妇血清HBV-DNA水平的影响

Effect of tibivudine on blocking mother-to-child transmission of HBV in pregnant women with high HBV viral load and its effect on reducing serum HBV-DNA level in pregnant women

目的:探究高乙型肝炎病毒载量妊娠中晚期孕妇使用替比夫定阻断乙型肝炎病毒(Hepatitis B virus,HBV)母婴传播的效果。方法:选取我院2018年7月至2020年10月期间收治的97例高乙型肝炎病毒载量妊娠中晚期孕妇作为研究对象,根据随机数字表法分为DTF组(n=48)和LdT组(n=49)。DTF组口服替诺福韦酯(Tenofovir Disoprox,DTF)治疗,LdT组口服替比夫定(Telbivudine,LdT)治疗,对比两组孕妇血清乙肝病毒基因(Hepatitis B virus-DNA,HBV DNA)水平、外周血Treg/Th17平衡状态、HBV母婴传播率及不良反应。结果:治疗前后两组孕妇HBV DNA水平、HBV DNA转阴率、乙型肝炎E抗原(Hepatitis Be antigen,HBeAg)转阴率、HbeAg血清学转换率、Treg细胞、Th17细胞百分比、Treg/Th17比值、新生儿HBV感染率、不良反应发生率均无统计学意义(P>0.05)。结论:LdT与DTF两种药物对高乙型肝炎病毒载量妊娠中晚期孕妇治疗,均可有效阻断HBV母婴传播,调节免疫状态,降低HBV DNA水平,提升抗病毒效果,效果相当,安全性高,值得临床推广。

Objective:To investigate the effect of tibivudine on preventing mother-to-child transmission of Hepatitis B virus(HBV)in pregnant women with high viral load of Hepatitis B.Methods:A total of 97 pregnant women with high viral load of hepatitis B who were admitted to our hospital from July 2018 to October 2020 were selected as the study subjects,and were divided into DTF group(n=48)and LdT group(n=49)according to random number table method.The DTF group was treated with Tenofovir Disoprox(DTF)and the LdT group was treated with Telbivudine(LdT).Serum Hepatitis B virus-DNA(HBV DNA)level,Treg/Th17 balance in peripheral blood,HBV mother-to-child transmission rate and adverse reactions was compared between the two groups.Results:There was no statistical significance in levels of HBV DNA,HBV DNA negative conversion rate and Hepatitis Be antigen negative conversion rate,percentage of Treg cells and Th17 cells,Treg/Th17 ratio,neonatal HBV infection rate and incidence of adverse reactions in the two groups before and after treatment were.Conclusion:LdT and DTF can effectively block mother-to-child transmission of HBV,regulate immune status,reduce HBV DNA level and improve antiviral effect in the treatment of pregnant women with high HBV viral load in the middle and late stages of pregnancy.The effect is similar,and the safety is high,which is worthy of clinical promotion.