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目的研究替比夫定(Ld T)治疗妊娠中晚期乙型肝炎病毒(HBV)感染免疫耐受期高病毒血症孕妇的效果及停药后丙氨酸氨基转移酶(ALT)升高比例。方法选取该院2013年1月-2015年12月住院部确诊的HBV感染孕妇130例,观察组(102例)给予Ld T治疗,对照组(28例)不给予抗病毒治疗。统计治疗及分娩前后观察组血清HBV指标,记录分析观察组和对照组分娩后ALT升高比例,并对比两组婴儿HBV感染情况。结果观察组治疗1个月后HBV DNA水平明显低于治疗前,差异有统计学意义(t=27.601,P<0.001);观察组分娩前HBV DNA水平显著低于治疗前,差异有统计学意义(t=33.739,P<0.001);观察组分娩后1个月HBV DNA水平略低于治疗前,差异无统计学意义(t=0.266,P>0.05);HbsAg和HbeAg在治疗前、治疗1个月、分娩前及分娩后1个月4个时期均无明显变化,差异无统计学意义(P>0.05);观察组和对照组分娩前ALT均无升高,分娩后1个月内观察组出现1.96%ALT升高,略低于对照组的3.57%,差异无统计学意义(χ~2=0.687,P>0.05);分娩后6个月内观察组出现3.92%ALT升高,略高于对照组的3.57%,差异无统计学意义(χ~2=0.271,P>0.05);观察组无一例HbsAg阳性或HBV DNA阳性,对照组2例确诊感染HBV,差异有统计学意义(χ~2=7.253,P<0.01)。结论 LdT能明显降低妊娠中晚期HBV感染免疫耐受期高病毒血症孕妇的HBV DNA水平,并有效阻断母婴的HBV垂直感染,且安全性较高。
Objective To investigate the effect of telbivudine (Ld T) on pregnant women with immune-tolerant stage of hepatitis B virus (HBV) infection in the second trimester of pregnancy and the increase of alanine aminotransferase (ALT) after stopping treatment. Methods 130 pregnant women with HBV infection diagnosed inpatient department from January 2013 to December 2015 in our hospital were enrolled. The observation group (102 cases) was treated with Ld T and the control group (28 cases) without antiviral therapy. The serum HBV markers in the observation group before and after childbirth were statistically analyzed. The percentage of elevated ALT in the observation group and the control group after delivery was compared and the incidence of HBV infection was compared between the two groups. Results The level of HBV DNA in observation group after one month treatment was significantly lower than that before treatment (t = 27.601, P <0.001). The level of HBV DNA in observation group before delivery was lower than that before treatment, the difference was statistically significant (t = 33.739, P <0.001). The levels of HBV DNA in observation group one month after delivery were slightly lower than those before treatment (t = 0.266, P> 0.05) There was no significant difference between the two groups (P> 0.05). There was no increase in ALT before delivery and within one month after delivery Group had a 1.96% ALT increase, slightly lower than the control group 3.57%, the difference was not statistically significant (χ ~ 2 = 0.687, P> 0.05); 6 months after delivery the observation group showed 3.92% ALT increased slightly (Χ ~ 2 = 0.271, P> 0.05). No HbsAg positive or HBV DNA was found in the observation group and 2 cases in the control group were infected with HBV, the difference was statistically significant (χ ~ χ ~ 2 = 7.253, P <0.01). Conclusion LdT can significantly reduce the level of HBV DNA in pregnant women with HBV-infected pregnant women with HBV infection in the second and third trimester of pregnancy, and effectively block the vertical infection of HBV in pregnant women and infants with high safety.