妊娠期慢性乙型肝炎患者抗病毒治疗的疗效及安全性分析.docVIP

妊娠期慢性乙型肝炎抗病毒治疗的疗效及安全性分析 蒋小仙 黄文豹 吴旻 潘韵峰 厉慧琴 金洁 【摘要】 目的 探讨妊娠期慢性乙型肝炎抗病毒治疗的疗效及安全性。方法 研究对象为2010年1月至2013年12月就诊于杭州市第一人民医院和杭州西溪医院感染科，妊娠期发现肝功能异常（ALT≥2倍正常值）且HBV DNA≥5 log拷贝/ml的慢性乙型肝炎患者，接受抗病毒治疗（拉米夫定或替比夫定）组，与同期妊娠期护肝治疗组（多烯磷脂酰胆碱胶囊、腺苷蛋氨酸、水飞蓟素等）比较，比较两组的妊娠期肝病结局，严重不良事件和新生儿结局。结果 共纳入79例患者，妊娠期抗病毒治疗组47例，妊娠期护肝治疗组32例，2组患者基线资料比较无统计学意义（P0.05）。抗病毒治疗组随访至少于产后半年，抗病毒治疗总疗程不少于48周。妊娠抗病毒治疗组47例，失访3例，有2例发生难免流产，余42例均完成妊娠。护肝治疗组32例，失访2例，有2例发生流产，有2例因肝酶异常应个人要求终止妊娠，26例完成生育。抗病毒治疗组在产前ALT的复常率，乙肝DNA不可检测率存明显高于护肝治疗组（88.6%Vs60%；84.0%Vs0% ）。两组孕妇在剖宫产率、不良妊娠事件、产时出血率及新生儿的胎龄、体质量、身长及Apgar评分无统计学差异。抗病毒治疗组自然或人工终止妊娠率发生率及因肝酶异常住院率明显低于护肝治疗组（4.55% Vs 13.3%；6.81% Vs 26.7%），同时抗病毒治疗组乙肝母婴传播的风险明显降低(阻断失败率0%Vs 7.69%)。结论 妊娠期乙型肝炎活动患者抗病毒治疗有效，且安全性良好，可有效抑制乙肝病毒复制，降低转氨酶，并减少乙肝母婴传播的风险。 【关键词】 妊娠；肝炎 乙型 慢性；拉米夫定；替比夫定；疗效；安全性。 Efficancy and safty of antiviral therapy in pregnant chronic hepatitis B patients Jiang xiao-xian,Huang wen-bao,Wu min,Pan yun-feng,Li hui-qin,Jin jie.The First People’s Hospital of Hangzhou city,Department of Infectious Disease,Hangzhou,Zhejiang,310006,China ABSTRACT Objective To explore the efficancy and safty of antiviral therapy in active hepatitis B patient during pregnancy. Methods The patients,who were pregnancy or the fertile women and had abnormal liver function[alanine aminotransferase (ALT)≥2upper limit of normal]and HBV DNA level ≥5 lg copies/ml in the Department of Infectious Disease,The First People’s Hospital of Hangzhou city AND Hangzhou xi-xi Hospital from Jan 2010 to Dec 2013 were selected.According to the patients’will,The pregnant patients were divided into the antiviral treatment group receiving lamivudine or telbivudine and the liver-protective treatment group receiving polyene phosphatidyl choline,adenosylmethionine,etc.The efficancy and safty in the 2 groups were compared. Rusults A total of 74 paients were entered in this study.of them,44 pregnant patients were in the antiviral treatment group ,30 pregnant patients were in the liver-protective treatment group.There were no statistically significant di