论文部分内容阅读
目的探讨核苷(酸)类似物(NAs)用于阻断慢性乙型肝炎(CHB)感染孕妇乙型肝炎病毒(HBV)母婴传播的安全性和有效性。方法在知情同意的情况下对40例CHB孕妇孕前和(或)于孕期采用NAs行抗病毒治疗。其中孕前或妊娠早期开始治疗时间为妊娠早期18例,中期17例,晚期5例;服用拉米夫定(LAM)15例、替比夫定(LDT)23例、替诺福韦(TDF)2例。每日口服1片至分娩。孕妇孕期定期检测HBV DNA、HBV血清学标志物。新生儿出生后24 h内注射乙肝疫苗联合乙肝免疫球蛋白,于12月龄内检测血清HBV DNA和HBs Ag。结果 40例孕妇共产婴儿44例,母婴均平安。经抗病毒治疗后,37例(92.5%)孕母产时HBV DNA<106拷贝/m L,30例(75%)孕母HBV DNA定量检测结果测不出(转阴)。治疗期间未发生NAs不良反应。44例婴儿中39例HBV DNA和HBs Ag为阴性(另5例未检测),阻断率为100%。除1例确诊先心脏病、1例左手六指畸形(2例均有家族史)外,其余均发育正常。结论妊娠早、中、晚期应用NAs阻断HBV母婴传播均有效果,且较为安全。
Objective To investigate the safety and efficacy of nucleoside analogues (NAs) in the prevention of mother-to-child transmission of hepatitis B virus (HBV) in pregnant women with chronic hepatitis B infection. Methods Forty CHB pregnant women received antiviral therapy with NAs before and / or during pregnancy with informed consent. Among them, pre-pregnancy or pre-pregnancy treatment was started in 18 cases during the first trimester, 17 cases in the middle period and 5 cases in the late stage. Fifteen cases of lamivudine (LAM), 23 cases of telbivudine (LDT), tenofovir (TDF) 2 cases. Daily oral 1 to delivery. Pregnant women regularly tested during pregnancy HBV DNA, HBV serological markers. Newborns within 24 h after injection of hepatitis B vaccine combined with hepatitis B immunoglobulin, serum HBV DNA and HBs Ag within 12 months of age. Results 40 cases of pregnant women, 44 cases of communal babies, both mother and child were safe. 37 cases (92.5%) of pregnant women with HBV DNA <106 copies / mL after antiviral therapy, and 30 cases (75%) of pregnant women with HBV DNA undetectable (negative). NAs adverse reactions did not occur during treatment. Among the 44 infants, 39 were negative for HBV DNA and HBsAg (the other 5 were undetected) with a blocking rate of 100%. Except for 1 case of confirmed heart disease and 1 case of left-handed six-finger deformity (both had family history), the rest developed normally. Conclusions The application of NAs in the early, middle and late stages of pregnancy has the effect of blocking mother-to-child transmission of HBV and is safer.