摘要
目的 探讨高载量乙型肝炎病毒(HBV)感染孕妇使用替诺福韦阻断母婴传播的疗效及安全性.方法 选择2016年10月至2018年10月郑州大学第一附属医院感染科门诊及住院部收治的65例高载量HBV孕妇为临床研究对象,根据孕妇意愿将其分为治疗组35例和对照组30例.治疗组自孕24~28周起开始口服替诺福韦抗病毒治疗,300 mg/次,1次/d,至分娩后1个月.对照组孕妇不予处理.所有新生儿出生后均接受联合免疫预防.观察两组孕妇血清丙氨酸氨基转移酶(ALT)、肌酐及HBV DNA含量变化,检测所有婴儿7个月龄时的乙肝表面抗原(HBsAg)水平,同时记录两组新生儿的身长、体质量、头围及新生儿有无先天性异常、孕妇用药后不良反应发生情况.结果 分娩前,治疗组HBV DNA(log10)含量[(2.688±0.871)IU/ml]低于对照组[(8.052±0.594)IU/ml],差异有统计学意义(P<0.01).治疗组孕妇分娩前ALT水平较治疗前下降,差异有统计学意义(P<0.05).治疗组孕妇所生婴儿7个月龄时检测HBsAg均为阴性,阻断率为100.0%,与对照组(86.7%)比较,差异有统计学意义(P<0.05).两组新生儿均无先天性异常,生长发育良好.治疗组孕妇服用替诺福韦后1例出现轻度的恶心、呕吐,1例出现乏力、头晕,均可耐受,未停药.结论 高病毒载量乙肝孕妇使用替诺福韦可有效降低母婴传播率,且安全性好.
Objective To investigate the efficacy and safety of tenofovir in interrupting mother-to-infant transmission of pregnant women with high-load hepatitis B virus(HBV)infection.Methods Sixty-five pregnant women with high-load HBV infection admitted to the Department of Infectious Diseases of the First Affiliated Hospital of Zhengzhou University from October 2016 to October 2018 were selected as research subjects.Under the premise of voluntary selection,they were divided into treatment group(35 cases)and control group(30 cases).The treatment group started oral anti-viral treatment from the 24 th to 28 th week of pregnancy,300 mg once daily,until 1 month after delivery.The pregnant women in control group were not given antiviral therapy.All newborns received combination immunization.The changes of serum alanine aminotransferase(ALT),creatinine and HBV DNA levels in the two groups were observed.The levels of hepatitis B surface antigen(HBsAg)in all infants at age of 7 months were measured.The length,weight,head circumference,neonatal congenital abnormalities of the newborns and the adverse reactions of the pregnant women after medication were recorded.Results Bfore delivery,the content of HBV DNA(log10)was(2.688±0.871)IU/ml in treatment group,lower than the(8.052±0.594)IU/ml in control group,and the difference was statistically significant(P<0.01).The ALT level before delivery of pregnant women in treatment group was significantly lower than that before treatment,and the difference was statistically significant(P<0.05).All of the infants in the treatment group were negative at age of 7 months,and the prevention rate was 100.0%;compared with the prevention rate of control group(86.7%),the difference was statistically significant(P<0.05).There was no congenital abnormality in the two groups of newborns,and they grew and developed well.One patient in the treatment group suffered mild nausea and vomiting,one patient developed fatigue and dizziness after taking tenofovir,but all of the adverse reactions could be tolerable without drug withdrawal.Conclusions The use of tenofovir in pregnant women with high-load HBV infection can effectively reduce the rate of mother-to-child transmission and it is safe.
作者
张璐
冯晓丽
余雪
潘延凤
Zhang Lu;Feng Xiaoli;Yu Xue;Pan Yanfeng(Department of Infectious Diseases,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中国实用医刊》
2019年第13期100-102,共3页
Chinese Journal of Practical Medicine
关键词
替诺福韦
慢性乙型肝炎
母婴传播
Tenofovir
Chronic hepatitis B
Mother-to-infant transmission
