摘要
目的探讨慢性乙肝妊娠患者应用替诺福韦酯进行母婴阻断的效果及安全性。方法选取2015年12月-2018年12月该院接诊的慢性乙肝妊娠患者300例,根据治疗方法的不同分为两组,对照组(102例)接受常规保肝治疗,观察组(198例)在对照组基础上加用替诺福韦酯,两组新生儿娩出后均接受阻断治疗。对比两组治疗前及分娩前的肝功能、病毒学应答情况及乙肝母婴传播情况。结果与治疗前相比,观察组分娩前的谷氨酸氨基转移酶(ALT)、HBV-DNA水平均明显降低(均P<0.05),对照组均无明显变化(均P>0.05),并且观察组分娩前的ALT、HBV-DNA水平均显著低于对照组(P<0.05)。观察组孕妇的ALT复常率、HBV-DNA转阴率分别为97.98%和94.95%,均显著高于对照组的29.41%和4.90%(P<0.05)。观察组婴儿出生时、6月龄、12月龄的乙型肝炎表面抗原(HBsAg)阳性率、乙型肝炎病毒e抗原(HBeAg)阳性率、HBV-DNA≥100 IU/ml率均为0,显著低于对照组(P<0.05)。观察组的母婴阻断成功率为100.00%,对照组为82.35%(84/102),组间比较差异有统计学意义(P<0.05)。观察组新生儿出生5 min Apgar评分、出生体质量比较,差异均无统计学意义(均P>0.05)。结论慢性乙肝妊娠患者在孕期服用替诺福韦酯能够有效降低其血清HBV-DNA水平,改善肝功能,同时有效阻断乙肝病毒的母婴传播,降低新生儿的HBV感染率,且对母婴无明显不良反应,有较高的安全性。
Objective To explore the effect and safety of tenofovir dipivoxil in the treatment of pregnant women with chronic hepatitis B.Methods From December 2015 to December 2018,300 cases of CHB pregnancy were divided into two groups according to different treatment methods,the control group(102 cases)received routine liver protection treatment,the observation group(198 cases)added tenofovir dipivoxil on the basis of the control group,and both groups received blocking treatment after delivery.The liver function,virological response and mother to child transmission of hepatitis B were compared between the two groups before treatment and before delivery.Results Compared with before treatment,the levels of ALT and HBV-DNA in the observation group were significantly reduced before delivery(P<0.05),and there was no significant change in the control group(P>0.05),and the levels of ALT and HBV-DNA in the observation group before delivery were significantly lower than those in the control group(P<0.05).The rate of ALT normalization and HBV-DNA turning negative were 97.98%and 94.95%respectively in the observation group,which were significantly higher than 29.41%and 4.90%in the control group(P<0.05).The positive rates of HBsAg,HBeAg and HBV-DNA≥100iu/ml in the observation group were all 0,significantly lower than those in the control group(P<0.05).The success rate of blocking was 100%in the observation group and 82.35%(84/102)in the control group.There was significant difference between the two groups(P<0.05).There was no significant difference in Apgar score and birth weight between the two groups(P>0.05).Conclusion Taking tenofovir dipivoxil during pregnancy can effectively reduce the level of HBV DNA in serum,improve the liver function,effectively block the mother to child transmission of HBV,reduce the rate of HBV infection in newborns,and have no obvious adverse reactions to mothers and infants,with high safety.
作者
邓建松
代勇
徐一玲
魏柏
DENG Jian-Song;DAI Yong;XU Yi-Ling(Department of Public Health,Liyuan Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan,Hubei 430077,China)
出处
《中国妇幼保健》
CAS
2020年第13期2356-2359,共4页
Maternal and Child Health Care of China
基金
湖北省自然科学基金(2019CFB706)。
关键词
慢性乙型肝炎
妊娠
替诺福韦酯
母婴传播
母婴阻断
Chronic hepatitis B
Pregnancy
Tenofovir
Mother to child transmission
Mother to child block
