核苷(酸)类似物阻断 HBV 母婴传播的效果及安全性

摘要

Objective To analyze the safety and efficacy of chronic hepatitis B ( CHB) patients in pregnancy with nu-cle(t)side analogues (NAs) treatment to block mother-to-child transmission of hepatitis B virus (HBV).Methods The 40 CHB patients before and/during pregnancy were treated with the NAs with informed consent , included 18 patients were treated with the NAs in the whole pregnancy or from the first trimester pregnancy ,17 patients were treated from the second trimester pregnancy , 5 patients were treated from the third trimester pregnancy .In drugs, 15 patients taked lamivudine ( LAM) , 23 patients taked telbivudine ( LDT) , 2 patients taked tenofovir ( TDF) ( without stopping treated before delivery with NAs dose of 1 capsule per day ) .HBV DNA and HBV serological markers were detected on a regular basis in pregnant women during pregnancy .The newborns were injected vaccine and immune globulin within 24 hours after birth , were detec-ted HBV DNA and /HBsAg in serum within 12 months of age.Results The 40 pregnant women delivered 44 infants, mothers and infants were safe .All the pregnant women during pregnancy hadn't adverse reactions to the NAs .With the anti-viral treatment,92.5% motherhood (37 women) intrapartum HBV DNA were equal or below 106 copies/ml,75%(30 women)were below 106 copies/ml.39 infants were detected HBV DNA and/HBsAg within 12 months of age,and they were all negative, 5 infants weren't detected.Except 1 infant had congenital heart disease diagnosis , 1 infant had malforma-tion of six fingers on left hand ( both had family history ) , the rest of infants development were normally .Conclusion In the first,second and third pregnancy , to block mother-to-child transmission of HBV by using pregnant class B NAs is effec-tive and safety .%目的：探讨核苷（酸）类似物（ NAs）用于阻断慢性乙型肝炎（ CHB）感染孕妇乙型肝炎病毒（ HBV）母婴传播的安全性和有效性。方法在知情同意的情况下对40例CHB孕妇孕前和（或）于孕期采用NAs行抗病毒治疗。其中孕前或妊娠早期开始治疗时间为妊娠早期18例，中期17例，晚期5例；服用拉米夫定（LAM）15例、替比夫定（LDT）23例、替诺福韦（TDF）2例。每日口服1片至分娩。孕妇孕期定期检测HBV DNA、HBV血清学标志物。新生儿出生后24 h内注射乙肝疫苗联合乙肝免疫球蛋白，于12月龄内检测血清HBV DNA和HBsAg。结果40例孕妇共产婴儿44例，母婴均平安。经抗病毒治疗后，37例（92．5％）孕母产时HBV DNA＜106拷贝／mL，30例（75％）孕母HBV DNA定量检测结果测不出（转阴）。治疗期间未发生NAs不良反应。44例婴儿中39例HBV DNA和HBsAg为阴性（另5例未检测），阻断率为100％。除1例确诊先心脏病、1例左手六指畸形（2例均有家族史）外，其余均发育正常。结论妊娠早、中、晚期应用NAs阻断HBV母婴传播均有效果，且较为安全。