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目的 探讨妊娠中晚期服用替比夫定阻断HBV母婴传播的效果及其对HBV抗原胎盘透过率的影响.方法 选取2010年4月-2015年4月在我院行产检并分娩的高病毒载量慢性乙型肝炎孕妇240例,按照随机数字表法分为观察组和对照组各120例.对照组新生儿接受主被动双重免疫方案;观察组自孕妇妊娠20周开始服用替比夫定600 mg,qd,至产后12周,分娩新生儿同样接受双重免疫方案.监测孕妇入组时、分娩时及新生儿脐带血、6个月时血清HBV标志物、HBV-DNA的变化,计算HBsAg、HBeAg的胎盘透过率.观察有无药物不良反应,评价安全性.结果 ①阻断效果:分娩时观察组孕妇血清HBV-DNA水平较治疗前明显降低,差异具有统计学意义(P＜0.05);而对照组差异未见统计学意义(P＞0.05).观察组新生儿脐带血HBV-DNA阳性率明显低于对照组(0vs 19.67％,P＜0.05);随访6个月时新生儿血清HBsAg阳性率明显低于对照组(0 vs 14.2％,P＜0.05).②HBV抗原胎盘透过率:分娩时2组孕妇的血清HBsAg、HBeAg水平比较,差异无统计学意义(P＞0.05),新生儿脐带血HBsAg、HBeAg水平比较差异也无统计学意义(P＞0.05);2组的HBsAg、HBeAg胎盘透过率比较差异无统计学意义(P＞0.05).③安全性:2组孕妇及新生儿不良事件发生率比较差异无统计学意义(P＞0.05).结论 妊娠中晚期服用替比夫定可以有效阻断HBV母婴传播,且安全性高,但其不能降低孕妇HBV抗原水平及其胎盘透过率,其阻断母婴传播的机制主要与降低HBV-DNA水平有关.“,”AIM To investigate the effect of telbivudine on blocking mother-to-child transmission of HBV and its effect on HBV antigens placenta transmittance.METHODS Totally 240 cases of pregnant women were selected who were with high viral load chronic hepatitis B from April 2010 to April 2015,and were divided into observation group and control group (n =120) according to the random number table method.The newborn of the control group accepted the dual immunization program.The pregnant women of the observation group were given telbivudine from 20 weeks of gestation,to 12 weeks after delivery,600 mg,qd,and the newborns were also given double immunization program.The changes of the serum level of HBV-DNA and HBV markers of the pregnant women were monitored when into groups,birth and the umbilical cord blood of the neonatal and six months after birth.The placenta transmittance of the HBsAg and HBeAg was calculated.Adverse drug reactions were observed.RESULTS (1) Blocking effect:at the time of childbirth,the serum HBV-DNA level of pregnant women of the observation group was significantly reduced compared with before treatment,and the difference had statistical significance (P ＜ 0.05);the control group had no statistically significant difference (P ＞ 0.05).The HBV-DNA level of neonatal umbilical cord blood of the observation group was significantly lower than that of the control group (0 vs 19.67％),and the difference had statistical significance (P ＜ 0.05).Follow-up of 6 months the serum HBsAg positive rate of neonatal of the observation group was obviously lower than that of the control group (0 vs 14.2 ％),which had statistically significant difference (P ＜ 0.05).(2) The placental transmittance of the HBV antigens:the serum level of HBsAg and HBeAg of the 2 groups of pregnant women at the time of birth had no statistically significant difference (P ＞ 0.05),and the HBsAg and HBeAg level of the neonatal umbilical cord blood of the 2 groups had no statistically significant difference(P ＞ 0.05).The placenta transmittance of the HBsAg and HBeAg of the 2 groups had no statistically significant difference (P ＞ 0.05).(3) Security:the incidence of adverse events of the pregnant women and newborns of the 2 groups had no statistically significant difference (P ＞ 0.05).CON CLUSION The effect and safety of telbivudine in blocking mother-to-child transmission of HBV is good,but it can't lower the placenta transmittance of HBV antigens.The mechanism of block mother-to-child transmission is mainly associated with lower levels of HBV-DNA.