妊娠晚期应用拉米夫定阻断血清高HBV-DNA水平孕妇乙肝病毒宫内感染的疗效观察

目的探讨妊娠晚期应用拉米夫定抗病毒治疗血清高HBV-DNA水平孕妇阻断乙肝病毒宫内感染的疗效及孕妇血清HBV-DNA水平对新生儿宫内感染的影响。方法选择拟于我院进行生产的60例血清高HBV-DNA水平的乙肝病毒感染妊娠晚期孕妇,经知情同意后作为治疗组,孕检均检测孕妇静脉血清HBV-DNA〉1×106copies/mL,自孕28周始口服拉米夫定100 mg,1次/d,至分娩后1个月停服;按孕妇血清HBV-DNA水平选择80例作为观察组,不作抗病毒治疗干预。两组新生儿出生时采脐血检测HBsAg和HBV-DNA阳性率。结果治疗组新生儿脐血HBsAg和HBV-DNA阳性率明显低于观察组新生儿（P〈0.05）;观察组新生儿宫内感染率与乙型肝炎感染孕妇血清HBV-DNA含量呈正相关。结论妊娠晚期应用拉米夫定抗病毒治疗可有效阻断血清高HBV-DNA水平孕妇乙肝病毒宫内感染,拉米夫定对母体血清HBV-DNA水平的强效抑制可能是阻断感染的主要原因。

Therapeutic effects of Lamivudine in the interruption of intrauterine HBV infection in pregnant women with high HBV DNA levels at late pregnancy

Objective To investigate the therapeutic effects of Lamivudine in the interruption of intrauterine HBV infection in pregnant women with high HBV DNA levels at late pregnancy and the effects between HBV DNA levels of pregnant women and intrauterine infections of neonates.Methods 60 HBV-infected pregnant women with high HBV DNA levels at late pregnancy were selected as the treatment group after signing informed consent,whose HBV-DNA(>1×106 copies/mL) and were treated with Lamivudine(100 mg,po,once daily) from pregnancy at 28 weeks to one month later after delivery.And 80 pregnant women with different HBV DNA levels were selected as the control group without intervention of Lamivudine.The HBsAg and HBV-DNA were detected from the cord bloods of infants from both groups.Results The positive rate of HBsAg and HBV-DNA of infants in the treatment group were significantly lower than those of infants in the control group(P < 0.05).The intrauterine infection rates of infants in the control group were positively correlated with their HBV infections and the HBV DNA levels of their mothers.Conclusion Lamivudine can effectively interrupt intrauterine HBV infection in pregnant women with high HBV DNA levels at late pregnancy.Intensified depression for HBV DNA levels of the mothers may be the primary cause for Lamivudine to interrupt intrauterine HBV infections.