目的：探讨在妊娠晚期应用替比夫定阻断乙型肝炎病毒母婴传播的临床疗效和安全性。方法应用计算机检索中国生物医学文献数据库、万方医学数据库、中文科技期刊数据库、中国知网、PubMed、ISI web of knowledge、EMbase、Cochrane Library、BIOSIS Previews 等数据库，截止日期为2013年9月。参照纳入和排除标准进行文献筛选，采用 RevMan5.1软件进行Meta 分析。结果纳入文献11篇，共1241例孕妇，其中应用替比夫定602例，对照组639例；Meta 分析结果显示，随访6～12月龄婴儿，替比夫定组 HBsAg 和 HBV DNA 阳性率均低于对照组，差异有统计学意义[RR=0.15，95%CI（0.08，0.28），P＜0.00001；RR=0.12，95%CI（0.05，0.32），P＜0.0001]；替比夫定组孕妇分娩前 HBV DNA 水平低于对照组，差异有统计学意义[MD=-3.86，95%CI（-4.55，-3.16），P＜0.00001]；替比夫定组肌酸激酶升高率高于对照组，差异有统计学意义[MD=-3.86，95%CI（-4.55，-3.16），P＜0.00001]，应用替比夫定孕妇所产新生儿无畸形等并发症发生。结论替比夫定能阻断 HBV 宫内感染，其应用安全、有效。%Objective To systematically review the efficacy and safety of telbivudine in preventing moth-er-to-infant transmission of hepatitis B virus in the third trimester of pregnancy. Methods Chinese Biomedical Literature Database,WanFang Database Online,Chinese Scientific Journals Database,CNKI,PubMed,ISI web of knowledge,EMBASE,Cochrane Library and BIOSIS Previews were searched for related articles till September 2013. Two reviewers independently screened these articles according to inclusion and exclusion criterion. Meta-analysis was performed by using software Rvman 5.1. Results Eleven papers were included in this study,with a total of 1241 pregnant women,including 602 cases received telbivudine and 639 cases of control;Meta-analysis showed that, after a 6 to 12 month of follow-up,the seropositive rates for HBsAg and HBV DNA in babies of telbivu-dine-treated mothers were significantly lower than in babies of non-treated mothers [RR=0.15,95%CI(0.08,0.28), P<0.00001;RR=0.12,95%CI (0.05,0.32),P<0.0001,respectively];Maternal HBV DNA levels prior to delivery was significantly lower in telbivudine-treated women than in non-treated women[MD=-3.86,95%CI(-4.55,-3.16),P<0.00001];The rate of elevation in serum creatine kinase(CK) was significantly higher in telbivudine-treated moth-ers than in non-treated mothers [MD=-3.86,95%CI (-4.55,-3.16),P<0.00001];The neonates in telbivudine group were born without deformity and other complications. Conclusion Telbivudine is effective and safe in blocking HBV intrauterine infection.
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