乙型肝炎病毒母婴传播阻断结局的研究

Study on the outcome of blocking transmission of hepatitis B virus from mother to child

目的:研究乙型肝炎病毒(HBV)母婴传播阻断的结局。方法:前瞻性选取2020年4月至2022年3月于江门市新会区妇幼保健院产检门诊接受规律产前检查的孕妇6098例进行研究。于孕早期对这些孕妇开展HBV检查,将乙肝表面抗原(HBsAg)阳性的482例孕妇结合HBV-DNA定量值分成治疗组(HBV-DNA≥2×10^(5)IU/mL)280例、观察组(HBV-DNA<2×10^(5)IU/mL)202例。由妊娠肝病专科门诊对两组进行动态追踪随访,治疗组中HBV-DNA在2×10^(5)~2×10^(9)IU/mL之间的孕妇从妊娠28周起开始口服富马酸替诺福韦二吡呋酯,HBV-DNA>2×10^(9)IU/mL的孕妇从妊娠24周起开始口服此药,300 mg/d,观察组未开展抗病毒治疗,仅予以临床监测。定期检测各组的HBV载量和肝功能,随访到胎儿出生后12个月,对婴儿HBsAg和HBV-DNA阳性率进行测定,对比各组母婴阻断结局的差异。结果:妊娠24周时,治疗组的HBV-DNA水平较观察组高(P<0.05)。妊娠32周时及分娩时,两组的HBV-DNA水平均较妊娠24周时降低(P<0.05),两组的谷丙转氨酶(ALT)水平与妊娠24周时相比无显著差异(P>0.05),组间HBV-DNA及ALT水平对比无显著差异(P>0.05)。出生时、出生后6个月及12个月,两组均无1例婴儿出现HBsAg和HBV-DNA阳性。结论:对HBV-DNA≥2×10^(5)IU/mL的孕妇结合HBV载量的高低在合适孕周采用富马酸替诺福韦二吡呋酯进行抗病毒治疗能阻断HBV母婴传播,可作为阻断乙型病毒性肝炎母婴传播的重要措施之一。

Objective:To study the outcome of blocking mother-to-child transmission of hepatitis B virus(HBV).Methods:From April 2020 to March 2022,6098 pregnant women who received regular prenatal examination in the outpatient department of Maternity and Child Health Care Hospital,Xinhui District,Jiangmen City were prospectively selected for study.These pregnant women were screened for HBV in early pregnancy,and 482 HBsAg positive pre gnant women were divided into treatment group(HBV-DNA≥2×10^(5)IU/mL)280 cases and observation group(HBV-DNA<2×10^(5)IU/mL)202 cases.The two groups were dynamically followed up by the specialized clinic of gestational liver disease.In the treatment group,the pregnant women with HBV-DNA between 2×10^(5)~2×10^(9)IU/mL began to take tenofovir dipifurl fumarate orally from 28 weeks of gestation,and the pregnant women with HBV-DNA>2×10^(9)IU/mL began to take this drug orally from 24 weeks of gestation.300 mg/d,observation group did not receive antiviral treatment,only clinical monitoring.The HBV load and liver function of each group were detected regularly,and the positive rates of HBsAg and HBVDNA were measured at 12 months after the birth of the fetus,and the differences in the outcome of mother-to-child blockage were compared among the groups.Results:At 24 weeks gestation,the HBV-DNA level in the treatment group was higher than that in the observation group(P<0.05).At 32 weeks of gestation and delivery,HBV-DNA levels in both groups were decreased compared with 24 weeks of gestation(P<0.05),alanine aminotransferase(ALT)levels were not significantly different between the two groups compared with 24 weeks of gestation(P>0.05),and HBV-DNA and ALT levels were not significantly different between the two groups(P>0.05).At birth,6 months after birth and 12 months after birth,no infant in both groups showed HBsAg and HBV-DNA positive.Conclusion:Antiviral treatment with tenofovir dipifuroxide fumarate can block H BV transmission from mother to child in p regnant women with HBVDNA≥2×10^(5)IU/mL and can be used as one of the important measures to bloc k HBV transmission from mother to child.