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目的观察HBeAg阳性、HBV DNA高复制慢性HBV感染孕妇的HBsAg、HBeAg和抗-HBc胎盘透过率,进一步明确替比夫定阻断母婴传播的机制。方法回顾性分析在本院例行孕期检查以及产科分娩的HBeAg阳性、HBVDNA≥106IU/mL的慢性HBV感染孕妇84例,根据阻断HBV母婴传播方式不同分为常规双重免疫阻断组(常规组,15例)和双重免疫+替比夫定阻断组(替比夫定组,69例)。检测妊娠中晚期、分娩时母亲和新生儿脐带血清HBsAg、HBeAg及抗-HBc水平。结果两组之间母亲及新生儿HBsAg、HbeAg和抗-HBc水平无统计学差异(孕妇分娩时:HBsAg P=0.058,HBeAg P=0.065,抗-HBc P=0.727;新生儿脐血:HBsAg P=0.761,HBeAg P=0.225,抗-HBc P=0.924),且两组之间的HBsAg和HBeAg胎盘透过率亦无统计学差异(分别为P=0.172,0.163)。两组新生儿脐带血抗-HBc透过率均为阳性。结论妊娠中晚期替比夫定不能降低孕妇HBsAg、HBeAg水平和HBsAg、HBeAg的胎盘透过率,其阻断HBV母婴传播的机制可能主要与有效降低孕妇HBV DNA水平有关。透过率与母亲HBsAg和HBeAg水平不成平行关系。
OBJECTIVE: To observe the transmission of HBsAg, HBeAg and anti-HBc placenta in HBeAg-positive, HBV DNA replication-positive pregnant women with chronic HBV infection and to further clarify the mechanism of telbivudine in preventing mother-to-infant transmission. Methods A retrospective analysis of 84 pregnant women with HBeAg positive and HBVDNA ≥106IU / mL in chronic HBV infection during routine pregnancy examination and obstetric delivery in our hospital was retrospectively analyzed. According to the different modes of blocking HBV mother-to-child transmission, the patients were divided into routine double immunosuppressive group Group, 15 cases) and double immunization + telbivudine block group (telbivudine group, 69 cases). To detect the levels of HBsAg, HBeAg and anti-HBc in umbilical cord serum of mother and newborn during the second trimester of pregnancy. Results There was no significant difference in HBsAg, HBeAg and anti-HBc levels between the two groups (HBsAg P = 0.058, HBeAg P = 0.065 and anti-HBc P = 0.727 at the time of delivery; neonatal umbilical cord blood: HBsAg P = 0.761, HBeAg P = 0.225, anti-HBc P = 0.924), and there was no significant difference in the transmission of HBsAg and HBeAg between the two groups (P = 0.172, 0.163, respectively). The neonatal cord blood anti-HBc transmission rate was positive in both groups. Conclusion Telbivudine can not reduce HBsAg and HBeAg levels and HBsAg and HBeAg placental permeability in the second and third trimester of pregnancy, and its mechanism of blocking the transmission of HBV may be mainly related to reducing the level of HBV DNA in pregnant women. The transmission rate is not parallel to the mother’s HBsAg and HBeAg levels.