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目的研究不同孕期高病毒载量(HBV-DNA)病毒载量孕妇抗病毒治疗对母婴传播阻断免疫效率的影响。方法临床纳入120例我院2012年1月至2013年12月期间产科门诊收治的乙肝表面抗原(HBs Ag)阳性高HBV-DNA的孕妇作为研究对象(所有对象采用荧光定量PCR技术检测HBV-DNA病毒载量,其中HBV-DNA病毒载量>106拷贝/ml为高病毒载量)。将患者按随机数字表法分为4组各30例,分别为实验一组、实验二组、实验三组及对照组,分别在产妇孕20w、24w、28w口服替比夫定至分娩,对照组则不给予治疗。观察4组孕妇分娩时新生儿HBV-DNA病毒载量、HBs Ag、HBe Ag定量情况。结果治疗前4组患者ALT、HBV-DNA、HBs Ag以及HBe Ag水平均无差异,P>0.05;治疗后实验一组上述指标均明显低于实验二组、三组及对照组;且实验二组均低于实验三组;实验三组均低于对照组,均P﹤0.05。随访新生儿7-12月,发现实验一组ALT异常率及HBs Ag阳性率均低于实验二组、三组及对照组,实验二组均低于实验三组及对照组,实验三组均低于对照组,均P﹤0.05。结论对孕妇进行抗病毒治疗可有效阻止新生儿HBV病毒的感染,且治疗时间越早,HBV感染率越低,值得临床应用及推广。
Objective To study the effects of different pregnant women with high viral load (HBV-DNA) viral load on pregnant women’s anti-viral treatment on the immune efficiency of mother-to-infant transmission. Methods A total of 120 pregnant women with HBsAg positive HBV-DNA were enrolled in our department from January 2012 to December 2013 in our hospital from January 2012 to December 2013 (all subjects were tested for HBV-DNA by fluorescence quantitative PCR Viral load, where HBV-DNA viral load> 106 copies / ml is high viral load). The patients were divided into 4 groups of 30 cases according to random number table method, which were experimental group 1, experimental group 2, experimental group 3 and control group, respectively, telbivudine was delivered to pregnant women at 20w, 24w, 28w, Group is not given treatment. The HBV-DNA viral load, HBsAg and HBeAg in neonates during delivery were observed in 4 groups of pregnant women. Results There was no significant difference in ALT, HBV-DNA, HBsAg and HBeAg levels between the four groups before treatment (P> 0.05). After treatment, the above indexes in one group were significantly lower than those in the second group, the third group and the control group Group were lower than the experimental three groups; experimental three groups were lower than the control group, P <0.05. The follow-up of newborns from July to December showed that the abnormal ALT rate and the positive rate of HBsAg in experimental group were lower than those in experimental group two, three and control groups, the experimental two groups were lower than the experimental three groups and the control group, the experimental three groups Lower than the control group, all P <0.05. Conclusion Antiviral therapy for pregnant women can effectively prevent the infection of neonatal HBV. The earlier the treatment is, the lower the infection rate of HBV is worthy of clinical application and promotion.