替比夫定对乙型肝炎病毒母婴.docxVIP

恩曲他滨对乙型肝炎病毒母婴传播的阻断作用及安全性分析范玲燕姜秀浓万炯叶菁菁周文红摘要目的观察妊娠晚期应用恩曲他滨对乙型肝炎(以下简称肝炎)病毒(HBV)母婴传播的阻断作用和对孕妇、婴儿的安全性分析。方法选择HBsAg和HBeAg阳性,HBV DNA≥1×106copies/ml的孕妇118例,分为恩曲他滨组58例,对照组60例。恩曲他滨组自孕28周开始口服恩曲他滨600mg,1次/天,产后维持治疗6个月以上；对照组不服用恩曲他滨。比较两组受试者在孕28周、分娩时和产后6个月时血清HBV DNA水平；两组婴儿在出生后即刻肌内注射乙肝免疫球蛋白200IU；在出生即刻、1月龄和6月龄时肌内注射乙型肝炎疫苗各lOtzg。检测出生时、1月龄、7月龄时血清HBsAg及HBV DNA阳性率,以及7月龄时抗-HBs的水平。观察恩曲他滨组孕妇服药后的不良反应,新生儿的发育指标。结果血清HBV DNA水平孕28周时,恩曲他滨组与对照组比较,差异无统计学意义；分娩即刻恩曲他滨组(5.63±9.5)×103 copies/ml较对照组(2.60±3.50)×107 copies/ml明显降低,差异有统计学意义(P0.05)；产后6个月时恩曲他滨组(0.56±1.94)×106copies/ml与对照组(2.28±2.26)x 10 7copies/ml比较,差异有统计学意义。恩曲他滨组和对照组孕妇所生婴儿7月龄时母婴传播率分别为0和10％,差异有统计学意义(P0.05)。恩曲他滨组孕妇服药期间未发现明显不良反应；两组新生儿发育指标比较,差异无统计学意义,均未出现发育不良。结论恩曲他滨片可以有效地阻断HBV母婴传播,且安全性高,不影响婴儿生长发育。关键词恩曲他滨乙型肝炎病毒妊娠宫内感染Efficacy and Safety of Telbivudine in the Perinatal Transmission of Hepalitis B Virus. Fan Lingyan,Jiang Xiunong,Wan Jiong,YeJingJing,Zhou Wenhong.Department ofLiver,Ningbo No.2 Hospital,Zhejiang 315000,ChinaAbstract objectiveTo evaluate the preventing effect of telbivudine on mother-to-infant HBV transmission and its safety on thepregnant women and the infants by oral administration oftelbivudine from the third trimester of pregnancy.Methods Totally 118 pregnant women with positive HBsAg and HBeAg.and HBV DNA levels≥1×106 copies/ml were divided into two groupsrandomly.For thetelbivudine treated group(58 cases),telbivudine with dose of 600mg were oral administrated one time per day from the 28th weeks ofpregnancy to more than 6 months afterchildbirth.However,no telbivudine were administrated for the control group(60 cases).The serum HBV DNA levels in both groups were measured in the time of the 28th week of pregnancy,childbirth and the 6th month after childbirth,respectively.All of the infants in two groups were administrated with HBIG(200IU)with intramuscular injection(IM)after birthimmediately.Moreover,Hepatitis B vaccine(10ug)was injected into these infants in both groups in the different times,namely,thebirth,1 month and 6 months aft