高乙肝病毒载量孕妇母婴阻断挽救措施的探讨

摘要

Objective To compare the efficacy of telbivudine (LdT ) alone and LdT combined with hepatitis B immunoglobulin (HBIG) for gravidas with high HBV DNA load through large sample and prospective control study and to provide some data for preventing mother-to-infant transmission during late gestation .Methods Five hundred and seventy-four gravidas with chronic HBV infection visiting the First Affiliated Hospital of Xi'an Jiaotong University from January 2010 to December 2015 were enrolled in this study .Among them ,329 patients received LdT intervention ,180 patients received LdT + HBIG intervention ,and 65 patients received no intervention .Kinetics of HBV DNA load in pregnancy and safety after intervention were monitored .Results Compared to the control group ,HBV DNA load of gravidas both in LdT group and LdT + HBIG group declined obviously (F value was 202 .589 and 171 .347 ,respectively ,both P < 0 .05) .Compared to LdT group ,HBV DNA load in LdT + HBIG group dropped more significantly at the first 4 weeks after treatment (t = - 2 .427 , P < 0 .05) .Although there was no significant difference in proportion of patients whose HBV DNA load dropped below 106 IU /mL and 104 IU /mL at delivery between LdT group and LdT +HBIG group ,proportion of patients whose HBV DNA load dropped into safer range of below 103 IU /mL at delivery in LdT +HBIG group was significantly higher than that in LdT group (χ2 = 4 .476 , P < 0 .05) .Maternal and infant tolerance was good and adverse reactions were mild and no patients stopped intervention because of adverse reaction in LdT group and LdT + HBIG group . Differences in cesarean section rate ,premature birth rate and infant deformity rate were not significant in three groups (all P >0 .05) .Non and hypo response rate of infants in LdT group and LdT + HBIG group was not significantly different compared to that in the control group (χ2 value was 0 .422 and 0 .222 ,respectively ,both P > 0 .05) .Conclusion LdT combined with HBIG intervention during pregnancy can rapidly and safely depress HBV DNA load in high risk gravidas ,which can be measures for blocking mother-to-infant transmission of HBV .%目的 通过大样本 、前瞻性对照研究探讨替比夫定(LdT)联合乙肝免疫球蛋白(HBIG)孕期干预对高病毒载量母亲乙型肝炎病毒(HBV)DNA的抑制作用,为完善母婴阻断策略,提高阻断成功率提供数据.方法 该研究自2010年1月至2015年12月招募了在西安交通大学第一附属医院就诊的574例慢性乙型肝炎孕妇,其中329人接受LdT干预,180人接受LdT+HBIG干预,65人未接受干预,动态监测三组患者孕期病毒动力学变化及干预后的安全性.结果 LdT组 、LdT+HBIG组孕妇的HBV DNA载量较对照组均明显下降(F值分别为202.589、171.347,均P<0.05).与LdT组相比,LdT+HBIG组孕妇的病毒载量在干预后第一个4周下降更显著(t=-2.427,P<0.05),虽然两组在分娩前HBV DNA载量降至106 IU/mL及104 IU/mL以下的比率未见明显差异,但是至分娩前LdT+HBIG组HBV DNA载量降至更安全的范围,即103 IU/mL以下的比率更高(χ2=4.476,P<0.05).LdT组及LdT+HBIG组母婴耐受良好,出现的不良反应均为轻度反应,无因不良反应停用孕期干预的情况发生,三组剖宫产率 、早产率 、婴儿畸形率等比较均无明显差异(均P>0.05);与对照组相比,婴儿的无弱应答率均未见明显差异(χ2值分别为0.422、0.222,均P>0.05).结论 LdT联合HBIG孕期干预可安全且更快速地抑制高危孕妇的病毒载量,可能作为阻断乙肝母婴传播的挽救措施.