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目的探讨替比夫定与替诺福韦在乙型肝炎病毒(HBV)感染女性孕晚期中的应用效果。方法选取2014年7月-2015年10月邯郸市传染病医院门诊收治的HBV感染孕妇180例为研究对象,分为3组,每组60例。替比夫定组,口服替比夫定片;替诺福韦组,服用富马酸替诺福韦二吡呋酯片,两组均连续服用至分娩后4周。对照组不给予任何抗病毒药物,新生儿分娩后进行主、被动联合免疫。检测治疗前后3组血清病毒学指标HBeAg及HBV DNA含量,统计分娩前血清谷丙转氨酶(ALT)复常率、HBeAg转阴率及新生儿宫内感染发生率;分析3组治疗期间不良反应发生情况及治疗后的妊娠结局。结果与治疗前比较,治疗后4周至分娩前替比夫定组、替诺福韦组HBV DNA水平呈降低趋势,替诺福韦组明显低于替比夫定组,差异有统计学意义(P<0.01),停药后2个月两组又升高至治疗前水平(P>0.05);对照组治疗前后HBV DNA水平差异无统计学意义(P>0.05);分娩前替诺福韦组ALT复常率、HBeAg转阴率明显高于替比夫定组(P<0.05或P<0.01)。替比夫定组和替诺福韦组HBV宫内感染率为0.00%,对照组宫内感染率为8.20%,3组新生儿宫内感染率差异有统计学意义(P<0.05)。3组治疗期间不良反应发生率及妊娠结局方面差异均无统计学意义(P>0.05)。结论高病毒载量HBV感染女性在孕晚期应用替比夫定和替诺福韦进行抗病毒治疗均可有效抑制HBV复制,降低血清病毒载量,但替诺福韦阻断HBV母婴垂直传播的效果更佳显著,且母婴安全性好。
Objective To investigate the effect of telbivudine and tenofovir on the third trimester of pregnancy of hepatitis B virus (HBV) infected women. Methods A total of 180 pregnant women with HBV infection admitted to Handan Infectious Disease Hospital from July 2014 to October 2015 were selected as study subjects and divided into 3 groups of 60 cases. Telbivudine group, oral telbivudine tablets; tenofovir group, taking tenofovir disoproxil fumarate tablets, two groups were taken continuously until 4 weeks after delivery. The control group did not give any antiviral drugs, newborn childbirth after primary and passive combination immunization. The levels of serum HBeAg and HBV DNA in three groups before and after treatment were measured. The serum ALT normalization rate, HBeAg negative rate and neonatal intrauterine infection rate before delivery were calculated. Adverse reactions were analyzed during the three groups Situation and outcome of pregnancy after treatment. Results Compared with those before treatment, the levels of HBV DNA in telbivudine and tenofovir groups decreased from 4 weeks after treatment to before delivery, and were significantly lower in tenofovir group than in telbivudine group (the difference was statistically significant ( P <0.01). The levels of HBV DNA in control group before and after treatment did not change significantly (P> 0.05), but tenofovir Group ALT normalization rate, HBeAg negative conversion rate was significantly higher than telbivudine group (P <0.05 or P <0.01). The intrauterine infection rate was 0.00% in telbivudine group and tenofovir group, and the intrauterine infection rate in control group was 8.20%. The intrauterine infection rate in 3 groups was statistically significant (P <0.05). There were no significant differences in the incidence of adverse reactions and pregnancy outcomes between the three groups (P> 0.05). Conclusion HBV infection in women with high viral load in the third trimester of pregnancy with telbivudine and tenofovir antiviral therapy can effectively inhibit HBV replication and reduce serum viral load, but tenofovir block HBV vertical transmission of mother and child The effect is better and the maternal and child safety is good.